Date of Award

2021

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

OBJECTIVE: The objective of this systematic EBM review is to determine “Does dupilumab decrease the amount of asthma exacerbations in patients suffering from asthma compared to placebo?”

STUDY DESIGN: A review of three randomized, placebo-controlled trials (RCTs) that were peer reviewed and published in English after 2009.

DATA SOURCE: All articles were published in peer reviewed journals and were researched using PubMed. Studies were selected based on their ability to answer the question posed in the objective, and if the researched outcomes were patient oriented.

OUTCOMES: Assessed outcomes were either the occurrence or rate of asthma exacerbations during the studies. The specifics of a defined exacerbation were similar, but minimally different between each randomized controlled trial. Exacerbations according to the authors are as follows:

  1. Wenzel (2013): “>1 systemic glucocorticoid burst, in patient hospitalization, or an emergency department visit for worsening asthma”
  2. Wenzel (2016): “deterioration of asthma that required the use of systemic corticosteroids for at least 3 days, or hospital admission or emergency department visit because of asthma treated with systemic corticosteroids”
  3. Rabe: “events leading to hospitalization, and ED visit, or treatment of >3days with systemic glucocorticoids at >2 times the current”

RESULTS: All three studies found that Dupilumab had a large treatment effect on patients with asthma and decreased exacerbations. Wenzel et al. (2013) found a NNT of three, with an odds ratio (OR) of 0.08 (95% CI, 0.02 to 0.28, p<0.001) in favor of intervention decreasing risk for exacerbation. Wenzel et al. (2016) had a NNT of seven, with a risk reduction percentage of 70.5% (95% CI, 45.4-84.1%, pvalue=0.0001) with Dupilumab intervention. And Rabe et al. found an RR of 0.407 (95% CI, 0.263 to 0.630) meaning there is less than half the risk of an exacerbation with intervention.

CONCLUSIONS: The results of these three studies showed that Dupilumab does decrease the amount of asthma exacerbations compared to placebo in patients suffering from asthma. However, further research with more patients needs to be conducted with more consistent treatment protocols to understand optimal dosing.

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