Am J Respir Crit Care Med

Dupilumab reduces mucus plugs, boosts lung function in moderate-to-severe asthma

November 5, 2025

Study details: The VESTIGE trial (NCT04400318) was a 24-week, randomized, placebo-controlled study in adults with moderate-to-severe asthma, elevated blood eosinophils (≥300 cells/μL), and FeNO ≥25 ppb. Participants received dupilumab 300 mg (n = 72) or placebo (n = 37) every two weeks. Mucus plug scores were assessed by high-resolution CT, and lung function and fractional exhaled nitric oxide (FeNO) were measured, with post hoc analyses stratified by baseline mucus plug score.

Results: At week 24, dupilumab significantly reduced the proportion of patients with high mucus plug scores (32.8% vs. 67.2% at baseline), while placebo showed no meaningful change. Dupilumab recipients were more likely to achieve FeNO <25 ppb (odds ratio, 6.64–8.54, P = 0.003–0.024) and demonstrated significant improvements in pre- and post-bronchodilator percent predicted FEV₁ (least squares mean difference, 16.77 and 12.70 percentage points, P<0.0001 and P=0.0055) and pre-bronchodilator forced vital capacity (FVC) in the high mucus plug subgroup.

Clinical impact: Dupilumab reduces mucus plug burden and improves lung function in patients with moderate to severe asthma, particularly in those with high baseline mucus plug scores. These findings support dupilumab as a disease-modifying therapy targeting airway obstruction due to mucus, with benefits extending to airway inflammation and asthma control.

Source:

Porsbjerg C, et al. (2025, October 27). Am J Respir Crit Care Med. Effect of Dupilumab on Mucus Burden in Patients with Moderate-to-Severe Asthma: The VESTIGE Trial. https://pubmed.ncbi.nlm.nih.gov/41145399/