What clinical features push you to add dupilumab instead of escalating ICS dose in a patient with biomarker-high asthma and recurrent exacerbations?

The Phase 3 QUEST study addressed this question and found that adding dupilumab to medium-dose ICS/LABA provided significantly better control than placebo plus high-dose ICS. However, this study did not look at actual dose escalation of the ICS prior to instituting the biologic. They also found no s...

I would consider adding dupilumab if the patient is already on twice-daily high-dose ICS/LABA; as many studies suggest meaningful improvement only occurs in this setting if you increase the ICS 2-4x. At that higher ICS level, typically > 1000 µg daily, the patient is likely to encounter dysphonia, t...

This study represents a post hoc analysis of the Phase 3 QUEST study in patients 12 and older with uncontrolled, moderate-to-severe asthma. It included 1582 patients with Type 2 inflammatory asthma and demonstrated that dupilumab + medium-dose inhaled steroids decreased asthma exacerbations by 70% c...