Investigator, BC Children's Hospital
Head, Division of Respiratory Medicine, Department of Pediatrics, University of British Columbia
Professor, Department of Pediatrics, Faculty of Medicine, University of British Columbia

A win-ratio analysis of the phase 3 VOYAGE trial found children with moderate-to-severe type 2 

 were more than twice as likely to achieve favorable outcomes on add-on dupilumab than placebo, regardless of whether they started on medium- or high-dose inhaled corticosteroids (ICS), according to Sharon Dell, MD, FRCPC, professor and head of the Division of Respiratory Medicine in the Department of Pediatrics at the University of British Columbia. 

Dupilumab Scores on Win-Ratio Analysis in Pediatric Asthma: Sharon Dell, MD

Dell discussed the findings, presented as a poster at the 

European Respiratory Society (ERS) International Congress, held in Barcelona from September 5-9

. Win-ratio analysis, still uncommon in pediatric asthma trials, compares each treated patient against each placebo patient across a hierarchy of outcomes, moving to the next-ranked outcome only when a pair ties; Dell said the method has already supported at least 2 FDA drug approvals and is more established in cardiovascular research, where it allowed rare outcomes like death to be weighed alongside more common ones.

The analysis ranked exacerbation freedom over 52 weeks as the top-priority outcome, followed by fewer exacerbations, normal lung function at week 52, and achieved asthma control (Asthma Control Questionnaire-5 score under 1.5). Dell said exacerbation freedom was placed first because exacerbations are the primary endpoint used to approve biologic therapies in asthma, while lung function was prioritized above symptom control specifically for children, since normal childhood lung function is associated with better respiratory outcomes in adulthood. Among children on high-dose ICS at baseline, dupilumab won 57.2% of pairs versus 26.7% for placebo, for an overall win ratio of 2.14 (95% CI, 1.35-3.40), with dupilumab prevailing in 68.2% of non-tied pairs.

 Among children on medium-dose ICS, the win ratio was 2.31 (95% CI, 1.45-3.68), with dupilumab winning 69.8% of non-tied pairs.

“The win ratio analysis translates really nicely into clinical messaging, because it tells us that, overall, you're more than twice as likely to have better asthma outcomes if you take dupilumab compared to placebo,” Dell said.

Because outcomes were similar across ICS strata, Dell said the findings raise a practical question about treatment timing. In Canada, children must remain on high-dose ICS for at least 6 months before qualifying for biologic therapy, but she noted this analysis suggests similar benefit even from a medium-dose ICS starting point. “It does beg the question of are we starting too late,” she said, adding that children may be more sensitive to the effects of prolonged high-dose ICS than adults. VOYAGE previously showed that by week 52, 46% of children receiving dupilumab achieved on-treatment clinical remission.

Dell S, Guilbert TW, Gappa M, Xia C, Ledanois O, Gall R, Bacharier LB. Win ratio analysis of dupilumab achieving on-treatment clinical remission in children with moderate-to-severe type 2 asthma. Poster presented at: European Respiratory Society (ERS) International Congress; September 5-9, 2026; Barcelona, Spain.

Bacharier LB, Guilbert TW, Zangrilli J, et al. Dupilumab in children with uncontrolled moderate-to-severe asthma. 

 2021;385(24):2230-2240. doi:10.1056/NEJMoa2106567

Videos

Dell discusses an analysis of VOYAGE showing dupilumab more than doubled the odds of favorable asthma outcomes in children, regardless of baseline ICS dose.

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Hilary Ugras, NP, is a nurse practitioner in GI motility at Beth Israel Deaconess Medical Center.

This episode, titled ‘Addressing Diagnostic Delays in EoE,’ features panelists examining barriers that can contribute to delayed diagnosis and the important role advanced practice providers (APPs) can play in promoting earlier recognition of eosinophilic esophagitis. The expert faculty discuss how comprehensive patient histories can uncover adaptive eating behaviors and other clinical clues that may warrant earlier endoscopic evaluation rather than simply treating presenting symptoms.

Addressing Diagnostic Delays in EoE

The panelists highlight opportunities for APPs to collaborate with gastroenterologists and other members of the care team throughout the diagnostic journey. They describe how APPs can support continuity of care by managing patients in the clinic, coordinating with colleagues performing endoscopic procedures, and building trusted relationships with patients over time. The discussion also emphasizes peer education and communication with clinicians in emergency, urgent care, and primary care settings as potential ways to increase awareness of EoE earlier in the patient journey.

The panel then examines the clinical consequences of delayed diagnosis, undertreatment, or inadequate disease control. Persistent inflammation can contribute to progression from an inflammatory phenotype toward fibrostenotic disease, including esophageal rings, narrowing, and strictures. These changes can affect what and how patients eat and may have broader emotional, social, and professional consequences. The expert faculty also discuss the risk of food impaction, which may result in emergency care and urgent endoscopic intervention. Together, these considerations underscore why earlier recognition, appropriate diagnosis, and effective disease control are important for limiting the long-term burden of EoE.

In the next episode, ‘Induction and Maintenance Therapies in EoE,’ panelists will examine how available treatment approaches fit across the induction and maintenance phases of EoE care. The expert faculty also discuss assessing remission, maintaining long-term disease control, and adapting therapy as patients’ needs and preferences evolve.

Diagnostic delays in EoE can have consequences beyond persistent symptoms. The panel explores how earlier recognition and collaborative care may help address progressive esophageal remodeling and reduce long-term disease burden.

Video Series

Saakshi Khattri, MD, is a board certified Dermatologist, Rheumatologist and Internist and one of only a handful of triple board-certified physicians across the US.

In "The Next Five Years in Psoriasis: Remission, Access, and Combinations," the panel looks ahead to the advances and the unfinished work of the coming years.

The Next Five Years in Psoriasis: Remission, Access, and Combinations

Dr. Han hopes the field will embrace all components of psoriatic disease equally and reach consensus on remission for the joints, not just the skin. He points out that even very low disease activity still allows up to one joint, so the definitions themselves show how far the joint side has to go. He is encouraged that development has not truly slowed.

Dr. Han previews a next era of biologics using dual inhibition and multi-active designs that target several cytokines at once. He notes patients may soon face a once-a-year injection, something few would have believed five years ago, and stresses that even a strong landscape leaves room to improve quality of life. He returns forcefully to access, describing patients who watch drug commercials with a call to action they cannot fulfill because the nearest dermatologist is a four-hour drive and six months away.

Dr. Wright picks up the access thread, citing recent work showing that where a patient lives shapes which drug they receive first and maps onto disease burden. She calls these the social and commercial determinants of health that decide who ever gets a chance at remission.

Dr. Wright wants the field to unpack what challenging-to-manage and treatment-refractory truly mean, ideally with predictive biomarkers so patients do not cycle through drugs while damage accrues. She insists on treating the whole person, including mental health, obesity, and cardiovascular risk, summed up in her line that bones hurt but heart kills. She predicts combination therapy will be essential for complex patients, even without large randomized trials to guide it.

Thank you for watching this HCPLive Peer Exchange series on psoriasis. Please subscribe to our eNewsletter for information on upcoming video series.

In ‘The Importance of Early Diagnosis in EoE,’ our panel explores why recognizing eosinophilic esophagitis as a chronic, progressive disease reinforces the need for timely diagnosis and disease control. The expert faculty discuss how persistent, untreated inflammation can contribute to esophageal remodeling, fibrosis, and stricture formation over time, emphasizing that the goals of care extend beyond addressing a patient’s immediate symptoms.

The Importance of Early Diagnosis in EoE

The panelists examine how diagnostic delays may increase the risk of fibrostenotic disease and explain why this is particularly important when counseling younger patients who may have decades of disease ahead of them. They discuss the challenge of communicating long-term risks to patients who may be minimally symptomatic or feel better after an acute event, such as a food impaction that resolves spontaneously. Rather than focusing exclusively on short-term symptom relief, the panel emphasizes the importance of identifying and treating underlying inflammation to help prevent disease progression.

The expert faculty also share practical approaches for helping patients understand the chronic nature of EoE and the value of pursuing diagnostic evaluation. Visual models of the esophagus and relatable analogies can help patients conceptualize inflammation and structural changes that they cannot see or may not yet feel. Throughout the discussion, the panel underscores the importance of patient education and shared understanding in encouraging appropriate evaluation and long-term engagement in care. Ultimately, earlier diagnosis provides an opportunity to address inflammation before progressive structural changes create a greater clinical burden for patients.

Our next episode, ‘Addressing Diagnostic Delays in EoE,’ examines how APPs can help overcome barriers to earlier EoE recognition through comprehensive histories, collaboration, and clinician education. The panelists also discuss how delayed diagnosis and inadequate disease control can contribute to fibrostenotic progression and greater long-term disease burden.

Early EoE diagnosis is about more than relieving symptoms today. The panel explores how timely recognition and treatment of inflammation may help limit progressive structural changes and protect long-term esophageal health.

In topline interim phase 1b findings, a single 720-mg subcutaneous dose of zumilokibart (APG777), Apogee Therapeutics' long-acting anti-interleukin-13 (IL-13) monoclonal antibody, produced rapid and sustained suppression of fractional exhaled nitric oxide (FeNO) in patients with mild to moderate 

, according to Mario Castro, MD, MPH, professor of medicine and chief of the Division of Pulmonary, Critical Care and Sleep Medicine at the University of Kansas School of Medicine. Castro discussed the data, presented at the 

Zumilokibart Rapidly Suppresses FeNO in Phase 1b Asthma Data: Mario Castro, MD

The trial (NCT06920901) randomized 19 patients with baseline FeNO of at least 25 ppb 3:1 to zumilokibart or placebo (14 and 5 patients, respectively).¹ By week 2, patients receiving zumilokibart had a mean FeNO reduction of 45.1 ± 15.7 ppb, a 60.2% ± 4.3% decrease from baseline, compared with 10.6 ± 7.5 ppb (10.2% ± 8.7%) with placebo.¹ Castro said the effect was durable, with mean reductions holding above 40 ppb and 50% through week 32; among the smaller subset of patients with extended follow-up, suppression persisted through week 48, though the evaluable sample had narrowed to 2 patients by that point. 

"I consider it a direct measure of airway inflammation," Castro said of FeNO, explaining that the biomarker is believed to reflect IL-13 activity in the airway epithelium and complements lung function testing and phenotyping in guiding treatment.

Zumilokibart was well tolerated: 11 of 14 patients (78.6%) had at least 1 treatment-emergent adverse event, compared with all 5 placebo patients, and neither group had a serious or grade 3/4 event or a discontinuation due to an adverse event.¹ Castro attributed much of the drug's profile to its extended half-life, measured at 75.3 to 77.5 days across doses tested and conferred by a YTE Fc modification that enhances antibody recycling. He said that duration could support dosing as infrequent as every 3 to 6 months, reducing burden on patients and clinicians and potentially helping close the post-exacerbation coverage gap that contributes to hospital readmissions. Apogee is also developing a bispecific candidate combining zumilokibart with an anti-thymic stromal lymphopoietin (TSLP) antibody, aimed at asthma and chronic obstructive pulmonary disease.

Castro noted that elevated FeNO combined with elevated blood eosinophils has separately been shown to predict roughly 2 to 2.5 exacerbations per patient over the following year, reinforcing the biomarkers' combined prognostic value, a relationship also described in a biomarker risk-scale model developed by other investigators.² Looking ahead, Castro said the field is moving toward disease-modifying, and potentially remission-inducing, therapy in severe asthma and COPD, with future interest in earlier use of long-acting biologics, even in childhood, pending additional safety data.

Castro M, Cole J, DeAngelo J, et al. A single dose of zumilokibart (APG777) durably suppresses FeNO through 32 weeks in patients with mild-to-moderate asthma. Poster presented at: European Respiratory Society (ERS) International Congress; September 5-9, 2026; Barcelona, Spain. Poster PA339.

Couillard S, Laugerud A, Jabeen M, et al. Derivation of a prototype asthma attack risk scale centred on blood eosinophils and exhaled nitric oxide. 

. 2022;77(2):199-202. doi:10.1136/thoraxjnl-2021-217325

Castro, of University of Kansas discusses interim phase 1b data showing rapid, durable suppression in patients with mild to moderate asthma.

John Oppenheimer, MD, clinical professor of medicine at Rutgers New Jersey Medical School and allergist at Pulmonary and Allergy Associates of New Jersey

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Victoria Johnson joined MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and is now an assistant managing editor for HCPLive and RheumatologyLive. She doesn’t have enough time for her numerous hobbies. You can reach her at vjohnson@mjhlifesciences.com.

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Kyle Hogarth, MD, professor of medicine and medical director of the Pulmonary Rehabilitation Program and director of the Alpha-1 Antitrypsin Deficiency Clinical Resource Center at University of Chicago Medicine. 

Kyle Hogarth, MD, urges physicians to complete Alpha-1 testing during every COPD or asthma workup, warning that skipped tests delay diagnosis.

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Patrick Campbell is the editorial director of HCPLive. Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter and/or multimedia specialist with the Pocono Record, Star News Group, and NJ Advance Media. He is the executive producer for multiple HCPLive podcasts, including Diabetes Dialogue, Don't Miss a Beat, Kidney Compass, Medical Ethics Unpacked, The Medical Sisterhood, and Skin of Color Savvy. 


Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

Novartis announced pelacarsen did not meet its primary endpoint in the phase 3 Lp(a)HORIZON cardiovascular outcomes trial despite Lp(a) lowering.

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Latest News

Dupilumab Scores on Win-Ratio Analysis in Pediatric Asthma: Sharon Dell, MD

Addressing Diagnostic Delays in EoE

The Next Five Years in Psoriasis: Remission, Access, and Combinations

The Importance of Early Diagnosis in EoE

Zumilokibart Rapidly Suppresses FeNO in Phase 1b Asthma Data: Mario Castro, MD