D2.93 - Differential effects of dupilumab in women with severe uncontrolled asthma

The pathophysiological differences in asthma and responses to treatment with monoclonal antibodies that may occur in women compared to men have recently been highlighted. The aim of this study was to analyze the effectiveness of dupilumab in routine practice after 12 months of follow-up and the related factors in women.

We studied all patients treated with dupilumab in our asthma unit since 2022. Clinical, functional, and inflammatory parameters were collected at the baseline visit. The difference between men and women in the parameters were registered and the differences in treatment effectiveness after 12 months of follow-up were studied. The Exacto and Clinical Remission scales were used as effectiveness parameters, according to the SEPAR REMAS consensus. Good+complete response and clinical remission were assessed, considering effectiveness according to intention to treat (all patients who were treated at the baseline visit and were evaluable for the effectiveness analysis were included in the analysis). We used the chi-square test and t-student in qualitative and quantitative analyses (mean analysis), respectively. 

A total of 70 patients were included, women N= 43 (61.4%), men N= 27 (38.6%) with a mean age of 50.49 (15.3) years, range 18-85 years. Among the clinical parameters, significant differences were found in the frequency of nasal polyposis associated with asthma (women 16.2%, men 37%, p<0.05), COPD (women 6.9%, men 25.9%, p<0.04),naive treatment  with dupilumab (men 59.2%, women 27.9%, p<0.01). The most frequent change in women was from mepolizumab to dupilumab in 22 cases (51% of the total). We also found differences in FEV1/FVC (women 70.3, men 62.5, p <0.02), and borderline significant differences in baseline FENO values ​(women 78.2 ppb, men 99.4 ppb, p<0.057). In the effectiveness data at one year, there were significant differences in good+complete response (women 38.7%, men 70.5%, p<0.04), although not in clinical remission

We found differences between men and women in patients treated with dupilumab in clinical and functional parameters. The effectiveness at 12 months in terms of good + complete response is significantly lower in women, possibly conditioned by a lower frequency of concomitant polyposis, and not being a first-line treatment, so it is possible that these are more complex patients and a higher frequency of treatment failure with monoclonal agents previously.