Journal club

Abstract

Established biologic therapies for eosinophilic asthma are given weekly. The SWIFT-1 and SWIFT-2 trials ( NEJM 2024; doi: 10.1056/NEJMoa2406673) investigated the efficacy safety of depemokimab, an ultra-long-acting biologic targeting interleukin-5, in patients with severe eosinophilic asthma. These phase 3A, randomised, placebo-controlled studies involved 792 patients (pooled across SWIFT-1 and SWIFT 2) with high eosinophil counts and a history of exacerbations despite medium- or high-dose inhaled glucocorticoids. Participants received either 100 mg of depemokimab or placebo at weeks 0 and 26, in addition to standard care. The primary endpoint was the annualised rate of asthma exacerbations over 52 weeks. In both SWIFT-1 and SWIFT-2 trials, depemokimab significantly reduced the annualised exacerbation rate compared with placebo (rate ratios of 0.42 and 0.52, respectively, p<0.001). However, no significant differences were observed between the groups for secondary endpoints, including the change in St. George’s Respiratory Questionnaire score or forced expiratory volume. Adverse events occurred at similar rates in both groups, suggesting a comparable safety profile. Overall, depemokimab demonstrated efficacy in reducing asthma exacerbations in patients with an eosinophilic phenotype, supporting its potential as a long-acting treatment option for severe asthma. Mepolizumab was the first targeted therapy approved for use in eosinophilic granulomatosis …