BACKGROUND: Several new biologics have been studied in patients with 
eosinophilic asthma with varying degrees of response on clinical outcomes. No 
head-to-head trial has directly compared the efficacy of these drugs.
OBJECTIVE: To synthesize data on the relative efficacy of benralizumab, 
dupilumab, lebrikizumab, mepolizumab, reslizumab, and tralokinumab using network 
meta-analysis.
DATA SOURCES: We searched PubMed from inception to December 15th, 2017.
DATA EXTRACTION AND SYNTHESIS: We used the 'frequentist' methodology with random 
effect models using primarily 'netmeta' function in R to generate network 
meta-analysis results. Outcomes assessed included changes in forced expiratory 
volume-in 1 s (FEV1), asthma control questionnaire (ACQ), and asthma quality of 
life questionnaire (AQLQ). We also separately analyzed the annualized rate 
ratios for asthma exacerbations for each drug and compared to placebo. For all 
outcomes assessed, all drugs were superior to placebo except tralokinumab. In 
terms of magnitude of effect, dupilumab, followed by reslizumab and benralizumab 
showed the greatest increase in FEV1, 0.16L (95% CIs: 0.08-0.24), 0.13L 
(0.10-0.17), and 0.12L (0.08-0.17), compared to placebo. While mepolizumab, 
followed by dupliumab, benralizumab, and reslizumab showed reductions in ACQ 
scores, in order of magnitude of effect, dupilumab, followed by mepolizumab, 
benralizumab, and reslizumab showed the greatest increase in AQLQ scores. All 
drugs decreased asthma exacerbations but the results were only significant for 
reslizumab and dupilumab.
CONCLUSIONS: All drugs except for tralokinumab showed improvements in FEV1, ACQ, 
and AQLQ. Only reslizumab and dupilumab were associated with statistically 
significant reductions in asthma exacerbation rates.