Asthma · Biologics for severe asthma
SWIFT-1 and SWIFT-2: Twice-Yearly Depemokimab in Severe Asthma
| Design | Two replicate phase 3A, randomised, placebo-controlled trials |
|---|---|
| Treatment | Depemokimab 100 mg subcutaneously at weeks 0 and 26, plus standard care |
| Control | Placebo plus standard care |
| Population | 762 patients with severe asthma and an eosinophilic phenotype despite medium- or high-dose inhaled steroids |
| Inclusion criteria | Blood eosinophils 300 cells/microlitre or above in the previous 12 months, or 150 or above at screening, with a history of exacerbations. |
| Follow-up | 52 weeks |
| Primary endpoint | Annualised rate of exacerbations at 52 weeks |
| Result | SWIFT-1: 0.46 per year (95% CI 0.36 to 0.58) versus 1.11 (0.86 to 1.43), rate ratio 0.42 (0.30 to 0.59), p<0.001. SWIFT-2: 0.56 (0.44 to 0.70) versus 1.08 (0.83 to 1.41), rate ratio 0.52 (0.36 to 0.73), p<0.001. Neither trial showed a significant difference in SGRQ score, so no inference was drawn on subsequent secondary endpoints. |
| Secondary endpoints | St George's Respiratory Questionnaire, symptom and control scores |
Depemokimab reduced the annualized rate of exacerbations among patients with severe asthma with an eosinophilic phenotype.
The trial authors, in the published abstract
The interest is the dosing interval, not the mechanism: six-monthly anti-IL-5 achieves what monthly agents achieve, which changes adherence and clinic burden rather than efficacy. Quality of life did not improve, as with MATINEE in COPD — a recurring pattern in the anti-IL-5 trials worth being honest with patients about.
Jackson DJ, Wechsler ME, Jackson DJ, et al. Twice-Yearly Depemokimab in Severe Asthma with an Eosinophilic Phenotype. N Engl J Med 2024 Dec 19;391(24):2337-2349.