Clinical usefulness of mepolizumab in severe eosinophilic asthma

Figures & data

Figure 1 IL-5 and eotaxin role in recruitment, survival, and function of eosinophils.

Abbreviation: IL-5, interleukin-5.

Table 1 “History” of mepolizumab: major studies since 2000

Author	Study population	Study design	Mepolizumab dosage	Observations/results
Leckie et al^Citation25	24 mild allergic asthma	Double-blind randomized placebo-controlled trial	2.5 mg/kg (n=8) or 10.0 mg/kg (n=8) IV	Decrease blood eosinophils for up to 16 weeks and sputum eosinophils at 4 weeks
Flood-Page et al^Citation27	362 persistent asthma	Randomized, double-blind, placebo-controlled parallel-group trial	250 or 750 mg IV	Mepolizumab treatment does not appear to add significant clinical benefit
Nair et al^Citation29	20 persistent sputum eosinophilia and prednisone asthma	Randomized, double-blind parallel-group trial	750 mg IV	Reduction of number of blood and sputum eosinophils and prednisone-sparing in patients who had asthma with sputum eosinophilia despite prednisone treatment
Haldar et al^Citation9	61 refractory eosinophilic asthma	Randomized, double-blind, placebo-controlled parallel-group study	750 mg IV	Reduction of exacerbations and improving AQLQ scores in patients with refractory eosinophilic asthma
Pavord et al^Citation10	621 severe eosinophilic asthma	Multicenter, double-blind placebo-controlled trial	75, 250, and 750 mg IV	Mepolizumab is an effective and well-tolerated treatment that reduces the risk of asthma exacerbations in patients with severe eosinophilic asthma
Ortega et al^Citation36	576 severe eosinophilic asthma	Randomized, double-blind double-dummy study	75 mg IV or 100 mg SC	Mepolizumab administered either intravenously or subcutaneously significantly reduced asthma exacerbations and was associated with improvements in markers of asthma control
Bel et al^Citation37	135 severe eosinophilic asthma	Randomized double-blind trial	100 mg SC	Significant glucocorticoid-sparing effect of mepolizumab, reduction of exacerbations, and improving control of asthma symptoms
ClinicalTrials.gov Identifier	Severe COPD subjects	Multicentered, randomized, placebo-controlled, double-blind parallel-group trial	100 or 300 mg SC	Study is ongoing, but not recruiting participants
NCT02105961^Citation35

Abbreviations: COPD, chronic obstructive pulmonary disease; AQLQ, asthma quality of life questionnaire; IV, intravenous; SC, subcutaneous.

Table 2 Standard and new potential biomarkers useful for asthma diagnosis and management

Procedure/type of sample	Advantage	Disadvantage
Bronchoscopy with biopsies and BAL	Present gold standard	Invasive procedure not very applicable in real-life setting
Eosinophils in induced sputum	Specific biomarker of airway inflammation	Sample not practical to collect
Peripheral eosinophilia	Easy blood sample collection	Subestimates value
Expired FeNO	Easily measurable with available device	Interpretation of results still controversial
Serum periostin	Easy blood sample collection	Data still controversial

Abbreviations: BAL, bronchoalveolar lavage; FeNO, fractional exhaled nitric oxide.

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GlaxoSmithKlineEfficacy and Safety of Mepolizumab as an Add-on Treatment in Chronic Obstructive Pulmonary Disease (COPD) Available from: https://clinicaltrials.gov/ct2/show/NCT02105961. NLM Identifier: NCT02105961Accessed March 5, 2016

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