Real-world effectiveness of dupilumab vs benralizumab and vs mepolizumab in severe asthma: The EU-ADVANTAGE study

<bold>Background:</bold> Dupilumab, benralizumab and mepolizumab are approved in severe asthma (SA), yet real-world comparative data are limited. <bold>Objective:</bold> To compare the real-world effectiveness of dupilumab vs benralizumab and vs mepolizumab in European patients with SA. <bold>Methods:</bold> Data were collected by physicians from the medical charts of their patients (aged ≥12 years) who had physician-confirmed SA and initiated dupilumab, benralizumab or mepolizumab treatment between May 2019 and Feb 2022 (index). Difference in baseline covariates were balanced with inverse probability of treatment weighting (IPTW). Asthma exacerbations and oral corticosteroid (OCS) prescriptions over the 12 months post-index were estimated using a doubly robust regression. <bold>Results:</bold> Dupilumab, benralizumab and mepolizumab cohorts included 1281, 406 and 414 patients, respectively. The majority of baseline covariates were balanced (standardised difference <10%) after IPTW. Dupilumab treatment significantly reduced asthma exacerbations and OCS prescriptions by 35% and 27% vs benralizumab and 23% and 21% vs mepolizumab, respectively (all <italic>p</italic><0.05) (<bold>Fig</bold>). <bold>Conclusion:</bold> In this retrospective chart review, dupilumab appeared to be more effective vs benralizumab or mepolizumab in patients with SA. The results may be useful in clinical decision-making; however, residual confounding due to unmeasured clinical characteristics may still be present. <fig><object-id>erj;64/suppl_68/PA2170/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>