Dupilumab was more effective than other biologics in achieving clinical remission in adults and adolescents with several types of severe asthma, based on data presented at the European Respiratory Society (ERS) 2026 International Congress.

Although several biologics are available for asthma treatment, their relative effectiveness in real-world clinical practice is not well understood, said lead author Giorgio W. Canonica, MD, professor of respiratory medicine at Humanitas University in Milan, Italy.

“Additionally, clinical remission is an emerging long-term treatment goal in asthma and was defined as no severe asthma exacerbations, no oral corticosteroid use, and stable or improved lung function in this study,” Canonica said.

Canonica and colleagues analyzed data from EU-ADVANTAGE, a multicenter retrospective study of patients aged 12 years or older with type 2 (T2) inflammatory severe asthma who initiated dupilumab, omalizumab, or an anti-interleukin (IL)-5 biologic between May 2019 and February 2022.

Overall, dupilumab-treated patients across several severity subgroups were significantly more likely to achieve clinical remission than omalizumab-treated patients, with odds ratios (ORs) of 2.12 for patients with T2 severe asthma (defined as eosinophil counts ≥ 150 cells/µL and fractional exhaled nitric oxide [FeNO] levels ≥ 25 ppb), 4.56 for patients with T2-high severe asthma (defined as eosinophil counts ≥ 300 cells/µL and FeNO levels ≥ 35 ppb), and 3.55 for patients with T2-high severe asthma and eosinophil counts ≥ 500 cells/µL.

Similarly, the ORs for the three severity groups favored patients treated with dupilumab vs anti-IL-5 biologics mepolizumab or benralizumab at 1 year after treatment initiation (OR, 1.57, 1.95, and 2.18, respectively).

The results were not unexpected, given the known efficacy of dupilumab in adults and adolescents with asthma, but the data highlighted the greater effectiveness of dupilumab across all three components of clinical remission compared to that of omalizumab or the anti-IL-5 biologics mepolizumab or benralizumab at 1 year after treatment initiation, Canonica said.

Only three of four clinical remission components outlined in the Global Initiative for Asthma report were included in the current study because no data were captured related to asthma symptom scores, Canonica said. “Additional studies in real-world settings with standardized clinical remission criteria are important to help confirm these findings,” he emphasized.

However, the current study’s real-world results support the increased likelihood that patients with severe asthma are more likely to achieve clinical remission on dupilumab than on other biologics and may help guide clinical decision-making, Canonica said.

Shared Decision-Making for Remission Goals

Although clinical remission has become a long-term treatment goal in severe asthma, full consensus on what constitutes clinical remission is lacking, said Kartik V. Shenoy, MD, professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University in Philadelphia, who was not involved in the study.

Overall, remission definitions typically include no exacerbations, symptom control, and stable or improved lung function, Shenoy said. “Current head-to-head biologic trials don’t exist and certainly don’t exist to compare different drugs and likelihood of remission,” he said. Comparing different trials of biologic agents is difficult given the differences in trial populations; consequently, real-world comparative effectiveness trials are important, he added.

The study did not include all biologics currently available for severe asthma, Shenoy noted. Another limitation was the use of FeNO, which has been shown as a biomarker that predicts success of dupilumab but not mepolizumab and has been associated with improved outcomes with omalizumab, but not validated, he said.

Despite the limitations, the study findings suggest that dupilumab could be a reasonable option in patients seeking clinical remission of asthma, said Shenoy. However, the choice of biologic should be a shared decision between the patient and the clinician, he said. “Asthma triggers, frequency of dosing administration, comorbid medical conditions, and clinical biomarkers are all important in determining which biologic is appropriate for each patient,” he added.

The study was sponsored by Sanofi and Regeneron Pharmaceuticals. Canonica disclosed receiving research grants from A. Menarini, AstraZeneca, GSK, HAL Allergy, Sanofi, Sanofi-Genzyme, and Stallergenes Greer. He also disclosed serving as a lecturer or an advisory board member for A. Menarini, Allergy Therapeutics, AstraZeneca, Celltrion, Chiesi, FAES, Firma, Genentech, GSK, HAL Allergy, INNOVACAREMD, Novartis, OM Pharma, Red Maple, Sanofi, Sanofi-Genzyme, Stallergenes Greer, and Uriach. Shenoy disclosed past advisory work for AstraZeneca and GSK.