Impact of Dupilumab for Severe Asthma on Fatigue, Quality of Life, Work Productivity, and Activity

Background: Severe asthma greatly impacts daily life. Although biologics such as dupilumab improve clinical outcomes, their effects on patient-reported outcome measures prioritized by patients remain largely unexplored. Objective: (1) To evaluate changes in fatigue, quality of life (QoL), and work and activity impairment over 12 months following dupilumab initiation in a large severe asthma cohort. (2) To explore differences between biologic-naive patients and switchers and assess the relationship with asthma symptom control. Methods: Dutch severe asthma registry data were used, measuring fatigue (Checklist for Individual Strength – Subjective Fatigue), QoL (Asthma Quality of Life Questionnaire), work and activity impairment (Work Productivity and Activity Impairment – General Health), and asthma symptom control (6-item Asthma Control Questionnaire) at baseline and at 3, 6, 9, and 12 months. Changes over time and mean improvement “on dupilumab” (baseline vs 3-12 months) were explored using linear mixed models. Results: Among 236 patients (45% biologic-naive), median (interquartile range) baseline scores were 38 (29 to 47) for fatigue, 5.1 (4.4 to 5.9) for QoL, 35% (10 to 70) for work impairment, and 50% (20 to 70) for activity impairment. Mean improvement “on dupilumab” was −3.3 (95% CI, −4.7 to −1.9) for fatigue, 0.4 (0.3 to 0.5) for QoL, −9% (−15 to −2) for work impairment, and −6% (−10 to −3) for activity impairment. Improvements were greater in patients with larger asthma symptom control improvement. Minimal clinically important differences were achieved by 50% for the 6-item Asthma Control Questionnaire, 46% for QoL, and 30% or less for fatigue and work and activity impairment, with higher rates among those impaired at baseline. Conclusions: Fatigue, QoL, and work and activity impairment improved following dupilumab initiation, though most patients did not achieve clinically relevant improvements. Effects on fatigue and work and activity impairment appear less pronounced compared with asthma symptom control, possibly due to irreversible impairments in some patients.