Mepolizumab has clinical benefits including oral corticosteroid sparing irrespective of baseline EGPA characteristics

Abstract

BackgroundThe MIRRA trial (GSK ID: 115921/NCT02020889) demonstrated that mepolizumab increased remission time and reduced oral corticosteroid (OCS) use compared with placebo in patients with relapsing or refractory eosinophilic granulomatosis with polyangiitis (EGPA). The present analysis investigated the impact of baseline characteristics on clinical outcomes and characterised the OCS-sparing effect of mepolizumab.MethodsIn a Phase III, randomised controlled trial for patients with EGPA (MIRRA), patients received standard of care plus mepolizumab 300 mg or placebo every 4 weeks for 52 weeks. The accrued duration of remission, the proportion of patients in remission at Weeks 36 and 48, and the proportion of patients with clinical benefit (remission, OCS, or relapse-related) were assessed according to baseline EGPA characteristic subgroups (post hoc). Mepolizumab-related OCS-sparing benefits were also quantified.ResultsAccrued duration of remission and the proportion of patients in remission at Weeks 36 and 48 were greater with mepolizumab than placebo across baseline subgroups: refractory disease, immunosuppressant use, EGPA duration, relapse number, and OCS use ≤20 mg·day−1. The proportion of patients with clinical benefit was greater with mepolizumabversusplacebo (range: 76–81%versus25–39%), irrespective of immunosuppressant use or EGPA duration. Patients treated with mepolizumabversusplacebo accrued significantly more weeks on OCS ≤4 mg·day−1(odds ratio [95% confidence interval]: 5.06 [2.47,10.38]) and had a mean of 1423.1 mg less per-patient OCS exposure over 52 weeks.ConclusionsMepolizumab treatment provided benefits to patients with EGPA across varying baseline clinical characteristics and can be considered an OCS-sparing treatment in EGPA.

Through the MIRRA and what we found there

“…In the current issue of ERJ Open Research , J ayne et al . [ 8 ] present the results of additional post hoc analyses conducted to further elucidate whether various aspects of the disease and treatment history can predict the response to mepolizumab. The study also aimed to provide additional insights into the OCS-sparing effects of mepolizumab in EGPA patients.…”