B22-22 Impact of Timely Versus Delayed Initiation of Dupilumab on Asthma-Related Outcomes in Patients With Asthma Following Severe Exacerbation

Rationale Delay in initiation with ICS-containing medications following an exacerbation may leave patients at risk for subsequent exacerbations. However, it is unclear if this effect applies to initiation of biologics post-exacerbation. The purpose of this study is to compare the outcomes of patients with timely versus delayed initiation of dupilumab after a severe asthma exacerbation. Methods In this retrospective observational study of Optum’s All-Payer Claims Database, patients ≥ 6 years old with evidence of asthma diagnosis (ICD-code), moderate-to-severe asthma based on ICS treatment, and classified as GINA 3-5, who had a severe asthma exacerbation episode between 10/2018-12/2023 were examined. Eligible patients were biologic-naïve, had dupilumab initiation within 12 months of first observed severe exacerbation (index date), and had ≥12 months of continuous enrollment following index date. A severe asthma exacerbation was defined as asthma-related emergency department (ED) visit or hospitalization, or ambulatory (outpatient or office) visit in addition to use of systemic corticosteroids. The timely cohort (TC) initiated dupilumab 0-90 days of index; while delayed cohort (DC) initiated dupilumab 91-365 days after index. Risk of asthma-related severe exacerbations, systemic corticosteroid (SCS) and inhaled albuterol-containing rescue medication use were assessed for both the TC and DC groups 12 months following the index exacerbations. Results A total of 1,483 patients met all eligibility criteria, 449 (30.3%) in the TC and 1,034 (69.7%) in the DC. Overall average age (SD) was 39.8 (17.9) years and 40.3% of participants were male. In the 12-month period following the index asthma exacerbation, the proportion of patients experiencing any exacerbation was lower in the TC than DC (44.1% vs 64.6%, p < 0.001; Figure 1) and mean number of exacerbations among patients with at least one exacerbation in the follow-up period was lower in the TC versus the DC (1.7 vs 2.3, p < 0.001). The mean count of SCS fills per patient was also lower in the TC than the DC (2.49 vs 3.76, p < 0.001), as well as the mean count of inhaled albuterol-containing rescue medication fills (4.33 vs 6.00, p < 0.001). Conclusion Timely initiation of dupilumab following a severe asthma exacerbation was associated with fewer subsequent exacerbations, lower SCS use, and reduced reliance on inhaled albuterol-containing rescue medication use compared with delayed initiation. These findings suggest that earlier initiation of dupilumab may improve clinical outcomes for patients with moderate-to-severe asthma following an exacerbation. This abstract is funded by: Sanofi and Regeneron Pharmaceuticals Inc.