Real-world changes in fatigue in severe asthma patients after starting anti-interleukin-4/13 biologic

<bold>Background:</bold> Fatigue is highly prevalent in patients with severe asthma and contributes to the disease burden. Dupilumab improves clinical outcomes in severe eosinophilic asthma, but its real-world effect on fatigue is unknown. <bold>Aim:</bold> To explore changes in fatigue during 12 months after dupilumab initiation in switchers and biologic-naïve patients. <bold>Method:</bold> Changes in fatigue (CIS-F) and asthma control (ACQ6) were analyzed over 12 months in adult patients who initiated dupilumab and were included in the Dutch severe asthma registry (RAPSODI). <bold>Results:</bold> Patients (N=243; 44% naïve) had a mean CIS-F score of 38 (12) at baseline, with 63% having severe fatigue (≥36). As compared to baseline, mean decrease on dupilumab was -3.3 (95%CI -4.6 ; -1.9) for fatigue and −0.45 (−0.57 ; −0.34) for ACQ6. Biologic-naïve patients had higher baseline fatigue scores, and larger decreases in fatigue on dupilumab (mean -4.7 (−7.0 ; -2.5)) as compared to switchers (mean -2.5 (−4.13 ; −0.94)) (Fig 1). A similar pattern was shown for ACQ6, with a −0.85 (−1.04 ; −0.66) decrease in naïve patients. After 12 months, 50% of patients still had severe fatigue. <bold>Conclusion:</bold> Dupilumab treatment is associated with reduced fatigue, with largest effects in biologic-naïve patients. However, clinical significance remains uncertain. Since 50% of patients still had severe fatigue despite biologic treatment, additional interventions should be considered. <fig><object-id>erj;64/suppl_68/PA4812/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>