The clinical effectiveness of mepolizumab treatment in severe eosinophilic asthma; outcomes from four years cohort evaluation

Abstract

Background

Clinical trials and real world studies demonstrated benefit of mepolizumab treatment in severe asthma but data on its effectiveness beyond 2 years remain limited. Herein, we provide mepolizumab treatment evaluation up to 4 years.

Methods

we studied all patients initiated on mepolizumab in our center from June 2017 to August 2018. Clinical outcomes data were retrieved from the local dendrite systems registry. Comparison analyses and logistic regression were conducted to explore longevity and predictors of response to mepolizumab treatment.

Results

a total of 66 patients initiated on mepolizumab with a median follow-up of 45.8 (42.4,48.1) months were included in the study [mean age 50.3 years (range 18-79), females 50 (73%) ]. At 20.7 months of treatment, 42 patients (63.6%) had positive response, 13 (19.7%) negative response, and 11 (16.7%) discontinued due to other factors. At 45.8 months, 35 (53%) patients were still on mepolizumab, 21 (31.8%) switched to a different biologic, and 10 (15.2%) discontinued biologics. Two deaths were recorded during the study period.

The median blood eosinophil was reduced from 0.43x10⁹/L (0.27, 0.75) to 0.04 (0.0, 0.1) (p < 0.00001)]. The median annual exacerbations were reduced from 6.0 (4,8) to 1.0 (0.0,3.0) (p < 0.00001), and mOCS use was reduced from59% to 29%, p = 0.001. The mean asthma control questionnaire-6 (ACQ6) improved from 3.1 ± 1.7 to 2.1 ± 1.3 (p < 0.00001).

Conclusions

mepolizumab clinical benefit was sustained over 4 years. However, approximately half of the cohort discontinued the treatment prompting the need for further research into the treatment response longevity.

Keywords:

• Mepolizumab
• eosinophilia
• asthma
• severe
• treatment response
• real world
• exacerbation
• oral corticosteroids dependency

Acknowledgements

All authors contributed to data collection, study design and execution. AHM, CR, and RA, performed data analysis and presentation with all authors contributed to manuscript writing and review. All authors agreed to the co-authorship of this manuscript.

Declaration of interest

AHM declares institutional and personal payment independent of this work for talks, advisory boards and research grants from AZ, GSK, BI, Chiesi, Teva, Novartis, Sanofi. This study was an investigator led and did not receive funding from pharmaceutical companies.

Guarantor statement

Professor Adel H Mansur is the guarantor of the content of the manuscript including the data analysis.

Additional information

Funding

This study is supported financially by the severe asthma donated funds of the University Hospitals Birmingham NHS charitable trust funds.