Real-Life Indirect Case Matched Comparison of Dupilumaband Tezepelumab on Airway Oscillometry - Letter Open Access - 2025

Q: What is the main outcome measure used to compare dupilumab and tezepelumab?

Airway oscillometry is used, focusing on peripheral airway resistance (R5-R20) and peripheral airway compliance via reactance area (AX).

Q: How were patients matched between treatment groups?

Patients were pairwise case matched on baseline R5-R20 and additionally matched on biologic treatment duration, inhaled corticosteroid dose, and BMI.

Q: Did dupilumab and tezepelumab differ in larger-airway lung function (FEV1)?

No significant difference in FEV1 response was reported between dupilumab and tezepelumab, even though greater peripheral airway improvements favored dupilumab.

Sep 29, 2026

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Retrospective real-life clinic outcomes compare severe refractory asthma patients with small airway dysfunction matched for baseline peripheral airway resistance (R5-R20) and additional confounders, receiving dupilumab or tezepelumab. Both groups showed type 2 inflammation at baseline, and improvements during treatment were quantified using airway oscillometry measures of resistance and reactance area. Dupilumab produced greater within-treatment gains and larger between-treatment differences for R5-R20 and AX, while larger-airway lung function (FEV1) showed no significant advantage. Responder analysis using proposed minimal clinically important differences further favored dupilumab for peripheral resistance and compliance.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

To the Editor

Study background and rationale

Methods and patient matching

Results: within-treatment and between-treatment comparisons

Responder analysis and clinical interpretation

Ethics and publication notes

Allergy LETTER OPEN ACCESS Real-Life Indirect Case Matched Comparison of Dupilumaband Tezepelumab on Airway Oscillometry Robert Greig | Rory Chan | Brian Lipworth Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK Correspondence: Brian Lipworth ([b.j.lipworth@dundee.ac.uk](b.j.lipworth@dundee.ac.uk)) Received: 27 June 2025 | Revised: 29 July 2025 | Accepted: 7 August 2025 Funding: The authors received no specific funding for this work. Keywords: airway oscillometry | asthma | case matched | dupilumab | small airways dysfunction | tezepelumab To the Editor, Systemic biologics such as dupilumab and tezepelumab penetrating the peripheral airways may ameliorate small airway dysfunction (SAD) working on downstream and upstream type 2 inflammatory pathways, respectively. However, there are no indirect comparisons between these two drugs using airway oscillometry (AO) to assess peripheral airway resistance as heterogeneity of resistance between 5 Hz and 20 Hz (R5-R20) and peripheral airway compliance as reactance area (AX) [1] . We report on retrospective outcomes of SAD in real-life clinic patients with severe refractory asthma on either dupilumabor tezepelumab having been approved by NHS Tayside severe asthma multidisciplinary team. Patients were case matched in pairwise fashion on the basis of baseline R5-R20 ≥0.10 kPa/L/s, as previously described by Chan et al. when indirectly comparing 3 months of treatment with dupilumab and benralizumab [2] . In addition, here, patients were also matched on biologic treatment duration, inhaled corticosteroid (ICS) dose, and BMI. All patients exhibited type 2 inflammation at baseline. Caldicott ethical approval was obtained prior to data collection, and patient consent was not required. There were no significant differences between groups in baseline values as shown in Table S1 . Twenty-two patients were case matched in pairs. Mean (95% CI) values for within-treatment improvements for relative % change for dupilumab and tezepelumab were respectively R5-R20: 53.92%(34.92, 72.92) p < 0.001 and 35.40%(12.25, 58.55) p < 0.01, AX: 60.53%(42.98, 78.07) p < 0.001 and 34.29%(12.93, 55.66) p < 0.01 (Figure 1) . Mean (95% CI) differences between treatments comparing dupilumab vs. tezepelumab were 18.52%(3.97, 33.07) p < 0.05 for R5-R20 and 26.23%(6.92, 45.55) p < 0.05 for AX. The within-treatment responses alongside the mean between differences are shown in Table 1. Responder analysis of the change in absolute values showed eight patients on dupilumab exceeded the MCID proposed by Abdo et al. [3] for both R5-R20 (≥0.06 kPa/L/s) and AX (≥0.65 kPa/L) compared to three patients on tezepelumab (x2 = 4. 55, p < 0 .05) . FIGURE 1 | Mean and 95% CI for % difference between dupilumaband tezepelumab in large airways as FEV1 (NS) and in small airways as peripheral resistance (R5-R20, p < 0.05) and peripheral compliance (AX, p < 0.05) . This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd. 260 Allergy, 2026; 81:260–262 [https://doi.org/10.1111/all.70014](https://doi.org/10.1111/all.70014) TABLE 1 | Within treatment response to either dupilumab or tezepelumab as mean (95% CI) change from baseline, along with the mean between difference (95% CI) . | Change in | Within dupilumab | Within tezepelumab | | Difference between treatments | | --- | --- | --- | --- | --- | | FEV1 (% predicted) | 24.43 (4 . 11, 44 .75)* | 26.53 (−7.92, 60.97) | | −2.09 (−37.41, 33.22) | | FEF25–75 (% predicted) | 66.13 (37.73, 94 . 54)*** | 47.17 (18 . 18, 76 . 16)** | | 18.96 (−13.55, 51.48) | | R5–R20 (% change) | 53.92 (34 .92, 72 .92)*** | 35.40 (12 . 25, 58 . 55)** | | 18.52 (3 .97, 33 .07)* | | AX (%

FAQs

What is the main outcome measure used to compare dupilumab and tezepelumab?

Airway oscillometry is used, focusing on peripheral airway resistance (R5-R20) and peripheral airway compliance via reactance area (AX).

How were patients matched between treatment groups?

Patients were pairwise case matched on baseline R5-R20 and additionally matched on biologic treatment duration, inhaled corticosteroid dose, and BMI.

Did dupilumab and tezepelumab differ in larger-airway lung function (FEV1)?

No significant difference in FEV1 response was reported between dupilumab and tezepelumab, even though greater peripheral airway improvements favored dupilumab.

Sep 29, 2026

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