Baseline asthma burden by inhaled corticosteroid dose: patients initiating dupilumab in RAPID

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Background: GINA recommends dupilumab for severe asthma uncontrolled on maximal therapy, including high-dose inhaled corticosteroids (ICS). Patients on high-dose ICS may be at higher risk of side effects. Aims and objectives: To explore asthma burden in patients on medium- and high-dose ICS initiating dupilumab in real-world settings. Methods: RAPID ( NCT04287621 ), a global, prospective registry, enrolled 719 patients aged ≥12 years starting on dupilumab for asthma (primary indication) per country-specific prescribing information. Endpoints: % with coexisting type 2 conditions; work time missed (previous week/working adults/Work Productivity and Activity Impairment [WPAI] questionnaire); past year asthma-specific emergency room (ER) visits; past year systemic corticosteroid (SCS) use for severe exacerbations. Results: Of 251 patients on medium- and 317 on high-dose ICS at baseline, 89.2% and 90.5% had coexisting type 2 conditions, respectively. Allergic rhinitis (75.7% and 76.0%) and chronic rhinosinusitis (31.9% and 40.1%) were most common. Of those with WPAI data, patients missed a mean (SD) 9.4 (23.1) h (n=102) and 10.1 (23.8) h (n=122) of past-week work. Mean (SD) SCS use in those with SCS data was 20.9 (39.9) d (n=131) and 22.5 (28.6) d (n=191); excluding patients without past-year SCS use, it was 23.4 (41.6) d (n=117/131) and 26.8 (29.3) d (n=160/191). Past-year ER visits were reported for 19.9% and 18.3%. Conclusions: Patients initiating dupilumab had a high prevalence of coexisting type 2 conditions and substantial asthma burden, including work time missed, SCS use, and ER visits, regardless of baseline ICS dose. Biologic initiation should be considered earlier in asthma management.

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