Mepolizumab versus placebo for asthma

SummaryInconsistent results have been reported regarding IL-5 blockade treatment in asthma. There were no direct between-treatment comparisons. Only differences between each drug and placebo were studied. We identified all RCTs with anti-IL5 treatments for patients with asthma over the 1990-September 2015 period. RCTs were searched on Medline, Cochrane and Embase. At least 50 patients were enrolled in each study. Outcomes considered were exacerbation rate reduction, FEV 1 changes, ACQ-5 improvement, adverse events and serious adverse events. A global meta-analysis was first conducted followed by an indirect comparison of each IL-5-targeting drug: benralizumab, reslizumab and mepolizumab. Further eosinophilic subgroup analysis and sensitivity analysis were also conducted in case of heterogeneity. Ten trials involving 3421 patients were eligible for meta-analysis. IL-5 blockade significantly reduced annual exacerbation rates vs. placebo by 40% [29-50] (P < 0.01, I 2 = 0.61). ACQ-5 was significantly improved vs. placebo but below the recognized MCID level (À0.31 [À0.41, À0.21], P < 0.01, I 2 = 0.11). FEV 1 changes from baseline were improved vs. placebo by 0.09 L [0.05-0.12] (P < 0.01, I 2 = 0.28). The subgroup analysis identified a slight additional improvement in mean treatment effects in eosinophilic (> 300 mm 3 /L) patients with severe asthma. Similar patterns and rates of adverse events and severe adverse events were reported with the three drugs. The data interpretations were not affected by the sensitivity analysis. IL-5 blockade appears to be a relevant treatment strategy to improve severe asthma management, particularly for eosinophilic patients. No clear superiority appeared between the drugs when appropriate doses were compared.

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“…Most of these results were expected , but a global meta‐analysis was lacking. Here, we selected significant studies and aggregated the results.…”

Section: Discussionmentioning

confidence: 99%

Comparison of anti‐interleukin‐5 therapies in patients with severe asthma: global and indirect meta‐analyses of randomized placebo‐controlled trials

Cabon

Molinari

Marin

et al. 2016

Clin Experimental Allergy

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“…No serious adverse events were reported. Interestingly, benralizumab reduced exacerbation in noneosinophilc asthma as well 128…”

Section: Therapeutic Targets In Childhood Asthmamentioning

confidence: 99%

Novel therapeutic targets for allergic airway disease in children

Giallongo¹,

Parisi²,

Licari³

et al. 2019

DIC

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The aim of precision medicine is setting up targeted therapies for selected patients that would ideally have high effectiveness and few side effects. This is made possible by targeted therapy drugs that selectively act on a specific pathway. Precision medicine is spreading to many medical specialties, and there is increasing interest in the context of allergic airway diseases, such as allergic rhinitis, chronic rhinosinusitis, and asthma. This review is an update of new targets in the treatment of childhood allergic upper airway diseases and asthma, including the most recent biologic drugs that have already been licensed or are in the pipeline to be tested with children.

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“…21 All but one of the studies used the intravenous route, which is not currently licensed, so no conclusion could be reached about its place in management. Concern was expressed over selection bias in several of the trials.…”

Section: Anti-eosinophil Therapiesmentioning

confidence: 99%

What is the evidence for different management options for difficult to treat severe asthma?

Bulletin¹

2017

BMJ

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Mepolizumab versus placebo for asthma

Cited by 8 publications

References 16 publications

Comparison of anti‐interleukin‐5 therapies in patients with severe asthma: global and indirect meta‐analyses of randomized placebo‐controlled trials

Comparison of anti‐interleukin‐5 therapies in patients with severe asthma: global and indirect meta‐analyses of randomized placebo‐controlled trials

Novel therapeutic targets for allergic airway disease in children

What is the evidence for different management options for difficult to treat severe asthma?

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