The spectrum of therapeutic activity of mepolizumab

ABSTRACT

Introduction: The basis of the development of the anti-interleukin-5 monoclonal antibody mepolizumab was the acknowledgment of the crucial importance of this cytokine in promoting eosinophils production, activation, and survival, which is associated with the eosinophilic asthma phenotype, as well as with other disorders characterized by high levels of eosinophils.

Areas covered: All the available literature on the outcomes treatment with mepolizumab in eosinophilic disorders are reviewed, including asthma, chronic rhinosinusitis, esophagitis, granulomatosis with polyangiitis, eosinophilic chronic obstructive pulmonary disease, hypereosinophilic syndrome, and allergic bronchopulmonary aspergillosis.

Expert opinion: The efficacy of mepolizumab in eosinophilic asthma is clearly demonstrated by a number of controlled trials and by meta-analyses. Among other eosinophilic disorders, controlled trials are available for chronic rhinosinusitis with nasal polyps, eosinophilic esophagitis, hypereosinophilic syndrome, eosinophilic granulomatosis with polyangiitis, and eosinophilic chronic obstructive pulmonary disease. Allergic bronchopulmonary aspergillosis, as well as other minor eosinophilic disorders, are backed only by case reports and are waiting controlled trials to verify the therapeutic role of mepolizumab.

KEYWORDS:

• Asthma
• chronic rhinosinusitis
• nasal polyps
• eosinophils
• IL-5
• mepolizumab
• monoclonal antibodies

Article Highlights

• Among biologic agents, the role of monoclonal antibodies is gaining increasing importance in many allergic and immunological disorders.

• The anti-Interleukin-5 monoclonal antibody mepolizumab is acknowledged as an effective treatment for the eosinophilic asthma phenotype, as well as for other disorders characterized by high levels of eosinophils.

• The efficacy of mepolizumab in eosinophilic asthma is clearly demonstrated by a number of controlled trials and by meta-analyses and is approved by regulatory agencies

• Among other eosinophilic disorders, controlled trials are available for chronic rhinosinusitis with nasal polyps, eosinophilic esophagitis, hypereosinophilic syndrome, eosinophilic granulomatosis with polyangiitis, and eosinophilic chronic obstructive pulmonary disease.

• Further approval by regulatory agencies concerns eosinophilic granulomatosis with polyangiitis (already acquired in USA), and chronic rhinosinusitis with or without nasal polips (under evaluation).

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One of the peer reviewers declares they have received speaker and advisory board honoraria from Genentech, Sanofi/Regeneron, AstraZeneca, Boehringer Ingelheim, GSK, Novartis, Teva, Merck, Circassia, Chiesi, Knopp Aerocrine and Almirall; payments to support FDA approval meetings from GSK; and grant support from Chiesi for a clinical trial. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.