Rationale: Severe asthma is burdened by relevant socio-economic and clinical impact. RCTs on Dupilumab showed efficacy and good safety profile, but post-market studies are needed.

Objectives: To evaluate the impact of Dupilumab on the use of anti-asthmatic drugs, including oral corticosteroids (OCS), the rates of asthma exacerbation-related hospital admissions, and healthcare costs in asthmatic patients.

Methods: Data were retrieved from Healthcare Utilization database of Lombardy Region, Italy. We compared healthcare resources use between the 6 months after Dupilumab initiation (?follow-up? period), the 6 months before Dupilumab initiation (?wash-out? period) and the corresponding 6 months of the prior year (?baseline? period).

Main Results: In a cohort of 176 patients, Dupilumab significantly reduced anti-asthmatic drugs use (including OCS and short-acting ?2-agonists, inhaled corticosteroids (ICS)/long-acting ?2-agonists and ICS alone) when comparing ?baseline? to ?follow-up? period. However, no differences were observed comparing ?wash-out? to ?follow-up? period. Considering hospital admissions, we observed a not statistically or marginally significant reduction between both before-Dupilumab and ?follow-up? periods. Six months discontinuation rate was 8%. Overall healthcare costs had a tenfold increase between ?baseline? and ?follow-up? periods, which was mainly led by biologic drug cost. Conversely, expenses connected to hospital admissions did not vary.

Conclusions: This study offers real-world evidence that Dupilumab reduced antiasthmatic drugs use, including OCS, in comparison to a corresponding period in the prior year. However, long-term healthcare sustainability remains an open issue.