A PHASE IV trial has demonstrated that dupilumab significantly reduces airway inflammation in patients with uncontrolled, moderate-to-severe type 2 asthma, providing new insights into disease management.
The VESTIGE trial was a randomised, double-blind, placebo-controlled study conducted at 72 research sites across 14 countries. It included 109 adult patients (mean age 50.4 years) with physician-diagnosed asthma who exhibited elevated blood eosinophil counts (≥300 cells/μL) and FeNO levels (≥25 ppb) despite treatment with inhaled corticosteroids and other controllers. Patients were randomly assigned (2:1) to receive either dupilumab 300 mg subcutaneously every 2 weeks or a placebo for 24 weeks. The primary endpoints were the proportion of patients achieving a FeNO concentration below 25 ppb and the percentage change in specific regional airway volumes corrected for lung volume at total lung capacity.
At week 24, 57% (41 of 72) of patients treated with dupilumab achieved a FeNO level below 25 ppb, compared to only 11% (4 of 37) in the placebo group (odds ratio: 9.8 [95% CI 3.1–30.8]; P<0.001). Dupilumab also resulted in a numerical increase in lung volume at total lung capacity, with a least squares mean percentage change of 19.7% (SE 8.1) versus -2.0% (11.5) for placebo, although this difference did not reach statistical significance (p=0.14). Safety findings were consistent with the known profile of dupilumab, with treatment-emergent adverse events occurring in 15% of the dupilumab group and 11% of the placebo group. No deaths were reported during the study.
These results suggest that dupilumab effectively reduces airway inflammation and mucus plugging in type 2 asthma, with potential benefits for lung function and disease control. The study highlights the value of functional respiratory imaging in assessing disease burden and monitoring treatment response, which may enhance clinical decision-making.
Ada Enesco, EMJ
Reference
Castro M et al. Effect of dupilumab on exhaled nitric oxide, mucus plugs, and functional respiratory imaging in patients with type 2 asthma (VESTIGE): a randomised, double-blind, placebo-controlled, phase 4 trial. Lancet Respir Med. 2025;13(3):208-220.
