Dupilumab Nearly Doubled Remission Odds in Type 2 Asthma, With Simon Couillard, MD

New research found dupilumab nearly doubled the likelihood of achieving clinical remission in patients with moderate-to-severe type 2 asthma, particularly among those with high eosinophils and elevated fractional exhaled nitric oxide (FeNO).

At the 2026 American Thoracic Society (ATS) International Conference in Orlando, Florida, investigator Simon Couillard, MD, FRCPC, MSc, from the Université de Sherbrooke, presented findings of the win ratio analysis of QUEST, a randomized, phase 3, placebo-controlled trial. The study evaluated dupilumab across key asthma remission domains, including exacerbation reduction, lung function improvement, and symptom control.

“What's really amazing about this analysis is we identified a subgroup of patients with a lot of inflammation that do beautifully well with this anti-inflammatory therapy,” Couillard said. “They get 4-fold more wins on the remission outcomes.”

The analysis focused on patients with type 2 inflammation, defined by blood eosinophils ≥ 150 cells/μL or FeNO ≥ 25 parts per billion, populations previously shown to benefit from dupilumab. However, Couillard emphasized that patients with both eosinophils ≥ 300 cells/μL and FeNO ≥ 35 parts per billion—what he referred to as “hot-hot” patients—demonstrated the strongest responses.

“We can identify a group of patients that do exquisitely well with the drug dupilumab, but not well at all with placebo,” he said. “Let's go after them and identify…and treat them earlier.”

The win ratio framework prioritized outcomes hierarchically based on clinical importance: exacerbation elimination first, followed by lung function stability or improvement, then clinically meaningful symptom improvement. Couillard noted the approach may provide a more comprehensive assessment of biologic benefit than analyzing endpoints independently.

According to Couillard, asthma attacks remain the most clinically meaningful endpoint because of their long-term impact on morbidity, healthcare utilization, and lung injury.

“Each additional asthma attack leaves a scar on your lungs and generates costs for the healthcare system,” he said.

The findings also reinforce the growing importance of biomarker-driven asthma management in clinical practice. Couillard encouraged pulmonologists to routinely evaluate blood eosinophils and FeNO when assessing patients for biologic eligibility and treatment expectations.

Couillard added that remission should increasingly become a treatment target in asthma care, similar to approaches used in rheumatology and inflammatory bowel disease. However, he cautioned that remission with biologics currently represents remission on treatment rather than sustained disease resolution after therapy discontinuation.

“With the biologics long term, we haven't been able to stop the biologics, unfortunately, in asthma, because patients will relapse,” he said.

Still, he argued remission-focused endpoints may help clinicians better communicate the multidimensional benefits of biologic therapy to both patients and healthcare systems.

The findings also support ongoing research into remission-focused asthma trials, including the upcoming HOT-HOT trial evaluating dupilumab in patients with highly elevated type 2 inflammatory biomarkers.

“The win ratio is widely used in cardiovascular disease and critical care, so it only makes sense that we try to adopt this endpoint in asthma now,” he said. “It’ll be exciting to see how the HOT-HOT trial, but also other analyses, play out in this field,” he said.

References

Couillard S, Petousi N, Pavord I, et al. Poster Board # P1412. Dupilumab Doubles the Likelihood of Achieving Clinical Asthma Remission in Patients with Moderate-To-Severe Type 2 Asthma: Win Ratio Analysis of Quest. Poster presented at ATS 2026 in Orlando, Florida, on May 18.