De-escalation of inhaled corticosteroids and other maintenance asthma therapies in dupilumab-treated patients with severe asthma: a real-world study.

BACKGROUND

Biologic therapies for severe T2-high asthma demonstrated oral corticosteroid-sparing effects, but evidence on the harmlessness of de-escalating inhaled corticosteroids and other in patients controlled with dupilumab remains limited.

OBJECTIVE

To evaluate, in a real-world setting, the clinical impact of de-escalating high-dose ICS, LAMA and LTRA in patients with severe asthma controlled with dupilumab.

METHODS

We conducted a retrospective bicentric observational study including 54 patients with severe asthma who initiated dupilumab between January 2022 and December 2023. Changes in maintenance therapy during the first year were classified as de-escalation, continuation, or never treated. Primary outcomes at 18 months included ACT score, acute exacerbation rate (AER), FEV1, their variation from baseline, chronic OCS use and clinical remission.

RESULTS

Dupilumab significantly improved asthma control, lung function, AER, and OCS use. The proportion of patients receiving high-dose ICS decreased from 85.1% at baseline to 47.1% at 18 months (p < 0.001). Similar trends for LAMA and LTRA. Primary outcomes at 18 months did not differ significantly between patients who de-escalated maintenance therapy and those who continued treatment. Clinical remission was achieved in 53.7% of patients at 12 months and 63.4% at 18 months. Maintenance therapy de-escalation did not affect the likelihood of achieving clinical remission, although nearly half of patients in remission remained on low-to-medium dose ICS.

CONCLUSIONS

In patients with severe asthma controlled with dupilumab, de-escalation of high-dose ICS, LAMA, or LTRA was not associated with clinical deterioration and did not preclude achievement of clinical remission.