A real-world analysis found that patients with asthma treated with dupilumab or tezepelumab experienced similar rates of exacerbations. After propensity matching, 22% of patients in both groups had at least 1 episode.

According to the abstract presented at CHEST 2025 in Chicago, dupilumab users showed slightly higher systemic corticosteroid use (45% vs 41%) and more inhaler changes (67% vs 63%). Adverse events occurred in 24% of dupilumab-treated patients and 18% of those receiving tezepelumab, most commonly dermatitis, conjunctivitis, pharyngitis, tonsillitis, and headache. Eosinophil levels decreased in both groups, with greater but nonsignificant reductions in the dupilumab cohort.

The retrospective cohort study drew on data from 69 health care organizations in the TriNetX network between January 2015 and December 2023. It included adults with asthma (ICD-10 J45.x) who initiated either biologic therapy. Patients using other biologics or those who were diagnosed with chronic obstructive pulmonary disease or bronchiectasis were excluded.

Propensity score matching adjusted for demographics, body mass index; comorbidities such as gastroesophageal reflux disease, dermatitis, or eczema; eosinophil and immunoglobulin E levels, inhaler use, and systemic steroid exposure. Prior to matching, dupilumab patients were generally younger (mean age was 37 vs 49 years), more likely to be male (42% vs 25%), and more likely to have dermatitis or eczema (39% vs 7%), while gastroesophageal reflux disease (30% vs 16%), obesity, and greater inhaler use were more common in the tezepelumab group. "Notably, the tezepelumab cohort had higher baseline inhaler usage, suggesting a reduction over time, resulting in comparable rates," noted Adeel Nasrullah, MD, BronxCare Health System in New York, along with colleagues. Patients on dupilumab therapy also had higher baseline eosiniphil counts than patients treated with tezepelumab (5.4 ± 5.5 vs 2 ± 2.5). After matching, each cohort comprised 949 patients.

The researchers noted that the retrospective design and reliance on electronic health record data limited control over confounding variables such as adherence and disease severity. The study did not report follow-up duration or dosing schedules, and definitions of exacerbations and adverse events depended on coding variability across institutions.

“These evidence-based findings offer valuable guidance for clinicians to personalize therapy, taking into account individual patient needs, insurance coverage limitations, specific side effect profiles, and personal treatment preferences,” the authors concluded.

Tariq Cheema reported receiving honoraria from various organizations, including BI, Regeneron, and Sanofi. The other authors reported no disclosures.