Real-world outcomes after biologic-to-biologic switching to dupilumab in adult asthma: A retrospective single-center cohort study

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BACKGROUND: Biologic agents have shown efficacy in decreasing exacerbations and hospitalizations in patients with asthma. However, some severe asthma cases are unresponsive to certain biologics. Comparative evidence for selecting an initial biologic-to-biologic agent switching strategy in asthma is limited. Herein, we aimed to compare the exacerbation outcomes between patients who switched to dupilumab and those who switched to other biologics. METHODS: This retrospective, single-center cohort study included adult patients with asthma receiving biologic therapy who switched biologic agents (January 1, 2016-September 30, 2025). The index date was the first dose of the newly administered biologic. Patients were followed for up to 12 months after the index date or until censoring. The primary outcome was the exacerbation rate (episodes per patient-year). The secondary outcome was the risk of experiencing ≥1 exacerbation(s). The exacerbation rate data were analyzed using negative binomial regression with an offset for person-time and adjustment for prior exacerbations (previous 12 months). RESULTS: Overall, 42 patients were included: 20 switched to dupilumab, whereas 22 switched to other biologics. In the primary negative binomial regression model adjusted for prior exacerbations, switching to dupilumab was associated with a numerically lower exacerbation rate compared with switching to other biologics (incidence rate ratio, 0.40; 95% confidence interval, 0.12-1.21). Sensitivity analyses using Poisson regression yielded consistent findings. CONCLUSIONS: An initial switch to dupilumab was associated with a lower 12-month exacerbation burden in this real-world cohort of patients with asthma, although the difference was not significant in the primary analysis.

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