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Comparative Efficacy of Anti IL-4, IL-5 and IL-13 Drugs for Treatment of Eosinophilic Asthma: A Network Meta-analysis

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Abstract

Background

Several new biologics have been studied in patients with eosinophilic asthma with varying degrees of response on clinical outcomes. No head-to-head trial has directly compared the efficacy of these drugs.

Objective

To synthesize data on the relative efficacy of benralizumab, dupilumab, lebrikizumab, mepolizumab, reslizumab, and tralokinumab using network meta-analysis.

Data sources

We searched PubMed from inception to December 15th, 2017.

Data extraction and synthesis

We used the ‘frequentist’ methodology with random effect models using primarily ‘netmeta’ function in R to generate network meta-analysis results. Outcomes assessed included changes in forced expiratory volume-in 1 s (FEV1), asthma control questionnaire (ACQ), and asthma quality of life questionnaire (AQLQ). We also separately analyzed the annualized rate ratios for asthma exacerbations for each drug and compared to placebo. For all outcomes assessed, all drugs were superior to placebo except tralokinumab. In terms of magnitude of effect, dupilumab, followed by reslizumab and benralizumab showed the greatest increase in FEV1, 0.16L (95% CIs: 0.08–0.24), 0.13L (0.10–0.17), and 0.12L (0.08–0.17), compared to placebo. While mepolizumab, followed by dupliumab, benralizumab, and reslizumab showed reductions in ACQ scores, in order of magnitude of effect, dupilumab, followed by mepolizumab, benralizumab, and reslizumab showed the greatest increase in AQLQ scores. All drugs decreased asthma exacerbations but the results were only significant for reslizumab and dupilumab.

Conclusions

All drugs except for tralokinumab showed improvements in FEV1, ACQ, and AQLQ. Only reslizumab and dupilumab were associated with statistically significant reductions in asthma exacerbation rates.

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Funding

This study was not sponsored by any funding agency or pharmaceutical company.

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Authors and Affiliations

  1. Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, 613 Michael St, NE, Atlanta, GA, USA

    Imran H. Iftikhar, Mathew Schimmel, William Bender & Colin Swenson

  2. Division of Allergy and Immunology, University of South Carolina School of Medicine, Columbia, SC, USA

    David Amrol

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  1. Imran H. Iftikhar
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  2. Mathew Schimmel
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  4. Colin Swenson
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Contributions

IHI had full access to all of the extracted data in the network meta-analysis and takes responsibility for the integrity of the data and the accuracy of the data analysis. IHI conceptualized and designed the study protocol, conducted the analyses and wrote the first draft manuscript. IHI, MS, WB, and CS contributed to assessment of study quality. All authors contributed substantially to the interpretation of analyses and in revisions of manuscript.

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Correspondence to Imran H. Iftikhar.

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Iftikhar, I.H., Schimmel, M., Bender, W. et al. Comparative Efficacy of Anti IL-4, IL-5 and IL-13 Drugs for Treatment of Eosinophilic Asthma: A Network Meta-analysis. Lung 196, 517–530 (2018). https://doi.org/10.1007/s00408-018-0151-5

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