Effects of Dupilumab in Children and Adolescents With Moderate-Severe Asthma: A Systematic Review of Clinical Trials

Objective: To evaluate the benefits and harms of Dupilumab in children and adolescents with moderate to severe asthma. Methods: We conducted a systematic search in Medline, Embase, Cochrane Controlled Register of Trials, and Clinical Trials Registries up to August 18, 2024. Whenever possible, we performed meta-analyses of the studies. The certainty of the evidence for each outcome was assessed using the GRADE methodology. Results: Seven publications from two multicenter RCTs were included. These studies included 408 children (6−11 years old) and 134 adolescents (12−17 years old). Both studies were funded by the pharmaceutical company that manufactures Dupilumab. The evidence suggests that Dupilumab probably leads to a substantial reduction in the annual rate of severe exacerbations (incidence rate ratio [IRR]: 0.46, 95% CI: 0.31−0.67; moderate certainty), particularly in children with a Th2 phenotype. Dupilumab probably improves quality of life to a clinically meaningful extent (RR: 1.18, 95% CI: 1.01−1.29; moderate certainty). However, it probably does not lead to a substantial improvement in asthma control (mean difference: −0.43, 95% CI: −0.56 to −0.30; two studies; moderate certainty; minimal-important-difference: 0.5). The frequency of serious adverse events may be similar between Dupilumab and placebo (4.8% vs. 4.5%; RR: 1.05, 95% CI: 0.41–2.68; low certainty). Finally, at 52 weeks, Dupilumab lead to an important increase in the Z-score pre-BD FEV1/FVC (RR: 1.45, 95% CI: 1.22–1.63; high certainty). Conclusion: In children and adolescents with uncontrolled moderate to severe asthma, particularly those with a Th2 inflammatory phenotype, the use of Dupilumab probably reduced the annual rate of severe exacerbations, increases both the percentage of children with good quality of life and pulmonary function parameters, with probably minimal serious adverse events.