Three-Year Real-World Outcomes With Dupilumab In Severe Asthma

Key Takeaways

• At 36 months, 59% of patients continued dupilumab and 41% had discontinued treatment.
• Among patients who remained on therapy for 36 months, exacerbations and oral corticosteroid use fell while asthma control and lung function improved.
• Remission was reported in a subset of continuers, and most patients who stopped treatment switched to another antibody.

Over 3 years, 95 of 160 patients, or 59%, remained on dupilumab in a multicenter German cohort report, while 41% discontinued treatment. The analysis included patients with severe asthma in a multicenter retrospective real-world study conducted in Germany. All had started treatment before March 2021, reflecting a pretreated severe asthma population. The multicenter cohort offers a real-world view of treatment persistence over extended follow-up. Outcomes separated into 2 clear patterns, with sustained gains among continuers and frequent treatment changes after discontinuation.

Follow-up was assessed at baseline and at 3, 12, and 36 months after treatment initiation. Investigators tracked asthma control, medication use, lung function, annualized exacerbation rates, and remission over time. Asthma remission was assessed specifically at 12 and 36 months, providing a separate view of disease status during follow-up. Together, these measures show how outcomes changed over time in this real-world severe asthma cohort.

Among patients who continued dupilumab for 36 months, annual exacerbations decreased by 1 from baseline, with P < .0001. Oral corticosteroid dose decreased by 5.5 mg/day, with P < .001, and Asthma Control Test score increased by 5, with P < .0001. Percent predicted FEV1 increased by 7% versus baseline, with P < .001, in the same continuing-treatment group. These changes were measured against baseline and were limited to patients who stayed on treatment for the full 36 months. Overall, the continuing subgroup showed sustained improvement in symptom control, steroid burden, exacerbations, and lung function.

Remission was reported separately for patients who continued treatment rather than for the full enrolled cohort. Within that group, 30% achieved remission at 12 months after starting dupilumab. At 36 months, 26% of continuers were in remission. This remission analysis adds a narrower endpoint than the broader changes in control, steroid exposure, exacerbations, and lung function. About one-quarter to one-third of patients who remained on therapy were in remission during follow-up.

Treatment discontinuation also remained common, with 65 patients, or 41%, stopping dupilumab after a median therapy duration of 8 months. After discontinuation, 55 switched to another antibody and 10 received no further antibody treatment. These patterns show that treatment trajectories often changed well before the 36-month mark. The investigators described dupilumab as an effective long-term option with sustained effects up to 36 months in this pretreated cohort. The treatment course in this cohort included both prolonged continuation for many patients and frequent switching after early discontinuation.