Real-World Effectiveness and the Characteristics of a “Super-Responder” to Mepolizumab in Severe Eosinophilic Asthma

Kavanagh, Joanne; d’Ancona, G; Elstad, Maria; Green, Linda; Fernandes, Mariana; Thomson, Louise; Roxas, C; Dhariwal, Jaideep; Nanzer, AM; Kent, Brian D.; Jackson, David J.

doi:10.1016/j.chest.2020.03.042

Cited by 143 publications

(126 citation statements)

References 16 publications

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“…A previous real-world study reported that the efficacy became fixed at 16 weeks in 80% of the cases and within 24 weeks in 90% of the cases. 40 In the present study, the mean interval before switching was 8.6 m to the first switch and 2.7 m to the second switch; after three biologics became available in 2018, the mean intervals decreased. Accordingly, an increase in the number of different biologics available may decrease the mean interval to switching biologics in clinical practice.…”

Section: Discussionsupporting

confidence: 38%

Effectiveness of Switching Biologics for Severe Asthma Patients in Japan: A Single-Center Retrospective Study

Numata¹,

Araya²,

Miyagawa³

et al. 2021

JAA

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Background In Japan, biologic therapy was initiated for patients with severe asthma in 2009. In recent years, four biologics with different mechanisms of action have become available in the clinical setting. However, the efficacy of switching between biologics remains uncertain. Methods To elucidate the efficacy of switching between biologics, 97 patients were enrolled who had received any biologic therapy for severe asthma at Jikei University Hospital, Tokyo, Japan, from July 2009 to December 2020. We retrospectively examined the patient characteristics, biomarkers, pulmonary function test results, selected biologics, and efficacy. Results Thirty-one males and 66 females received any biologics. The mean age was 53.3 years at the initiation of biologic therapy. Initially, 33, 41, 15 and eight patients received omalizumab, mepolizumab, benralizumab, and dupilumab, respectively. Among three representative indicators for biologics administration, the peripheral blood eosinophil count, serum IgE levels and fractional exhaled nitric oxide, 64% of the patients had two indicators, and 28% had three indicators. Thirty-four patients (35%) switched from the initial biologic to another, and the reasons for switching included persistent asthmatic symptoms (n=22), schedule of hospital visits (n=5), and other reasons. Thus, the treatment was effective in 11 patients after switching. In addition, two patients received combination therapy with different biologics. Eighteen patients (19%) interrupted treatment for various reasons. Regardless of whether the biologic was the initial therapy, the overall efficacy of the four biologics was 60% based on the global evaluation of treatment effectiveness. Conclusion Switching between biologics can be a promising option for severe asthma patients in whom treatment with an initial biologic is ineffective.

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Section: Discussionsupporting

confidence: 38%

Effectiveness of Switching Biologics for Severe Asthma Patients in Japan: A Single-Center Retrospective Study

Numata¹,

Araya²,

Miyagawa³

et al. 2021

JAA

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“…We suggested that SC fixed-dose mepolizumab administration significantly decreased blood eosinophil levels, asthma exacerbations, mOCS doses and impoved ACT scores in patients with SEA in agreement with the placebo-controlled studies and real life studies [6][7][8][9][14][15][16]. There were no significant change in FEV1 values after 12, 24 and 52 weeks of mepolizumab treatment, compared to baseline in agreement with some studies [7,[16][17][18][19]].…”

Section: Discussionsupporting

confidence: 86%

Effectiveness of mepolizumab therapy on symptoms, asthma exacerbations, steroid dependence, and small airways in patients with severe eosinophilic asthma

Yılmaz¹,

Bahçecioğlu²,

Türk³

et al. 2021

Turk J Med Sci

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Background/Aim: The efficacy of mepolizumab has been largely demonstrated in clinical trials in patients with severe eosinophilic asthma (SEA). However, reports on experience with mepolizumab in a real-life cohort are limited. Moreover, data about the effectiveness of mepolizumab on small airways is scarce. This study evaluated the effectiveness of mepolizumab therapy on symptoms, asthma exacerbations, blood eosinophils, steroid dependence and small airways in a real-life cohort of patients with SEA. Materials and methods:We retrospectively analyzed patients with SEA who were receiving fixed-dose mepolizumab. The effects of mepolizumab on clinical, laboratory, functional parameters were evaluated at 12 th , 24 th , 52 nd weeks. Small airways were assessed with the FEF 25-75.Results: A total of 41 patients were enrolled in the study. Mepolizumab significantly reduced asthma exacerbation rates, reduced mOCS dose, and improved asthma control test (ACT) scores at 12 th , 24 th and 52 nd weeks. However, we found no significant changes

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“…NP typically associates with late-onset eosinophilic asthma characterized by frequent exacerbations with increased OC dependence [25]. Furthermore, all anti-eosinophilic treatments, including omalizumab, can significantly improve nasal polyposis, and this improvement appears to be associated with a significant eosinophil reduction [25][26][27][28][29]. In conclusion, this real-life analysis indicates that mepolizumab has clinical benefits in patients with severe eosinophilic asthma, regardless of allergic or nonallergic characteristics.…”

Section: Discussionmentioning

confidence: 73%

Mepolizumab Effectiveness and Allergic Status in Real Life

Sposato

Scalese²,

Camiciottoli

et al. 2020

Int Arch Allergy Immunol

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Background: It is not clear whether mepolizumab is differently effective in allergic and nonallergic severe eosinophilic asthmatics (SEA) in real life. Objective: We tested mepolizumab effectiveness in allergic/nonallergic SEA in real life. A strict criterion to identify the 2 phenotypes was used. Method: We retrospectively considered 134 consecutive patients divided into allergic, with a positivity to at least 1 allergen to prick tests and/or IgE values ≥100 UI/mL (severe allergic eosinophilic asthma [SAEA]; n: 97–72.4%), and nonallergic, with no prick test results and normal IgE levels <100 UI/mL (severe nonallergic eosinophilic asthma [SNAEA]; n: 37–27.6%). They had taken mepolizumab for at least 6 months. Results: After 10.9 ± 3.7 months, improvements in FEV1%, FEF25–75%, exacerbation numbers, blood eosinophil (BE) counts, fractional exhaled nitric oxide (FENO) (ppb), percentages of patients that stopped/reduced short-acting β2-agonists (SABAs) or oral corticosteroid (OC), observed after treatment, were similar in both groups. Only Asthma Control Test (ACT) increases were higher in SNAEA (8 [5–9]) than in SAEA (5 [2.5–8.5]; p = 0.016). However, no differences were found after treatment in percentages of subjects with ACT ≥20, as well as with FEV1 >80%, FEF25–75 >65%, exacerbations ≤2, BE <300 cells/µL, and FENO <25 ppb between SAEA and SNAEA. Besides, no significant relationships were found, comparing SNAEA with SAEA, for FEV1% (β = −0.110; p = 0.266), FEF25–75% (β = −0.228; p = 0.06), BE counts (β = −0.012; p = 0.918), FENO (β = 0.234; p = 0.085), ACT (β = 0.046; p = 0.660), and exacerbations (β = −0.070; p = 0.437). No different associations between lung function and SNAEA occurrence when compared to SAEA condition (FEV1 >80%: OR = 1.04 [95% CI: 0.43–2.55], p = 0.923; FEF25–75 >65%: OR = 0.41 [95% CI: 0.08–2.03], p = 0.272) were detected. Neither all other parameters, such as ACT >20 (OR = 0.73 [95% CI: 0.32–1.63], p = 0.440), presence of exacerbations (OR = 1.35 [95% CI: 0.55–3.27], p = 0.512), SABA discontinuation (OR = 1.16 [95% CI: 0.40–3.39], p = 0.790), and OC cessation/reduction (OR = 3.44 [95% CI: 0.40–29.27], p = 0.258), were differently associated with 1 or the other phenotype. Conclusion: Mepolizumab can be considered as a valid therapeutic choice for either allergic or nonallergic SEA in real life.

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Real-World Effectiveness and the Characteristics of a “Super-Responder” to Mepolizumab in Severe Eosinophilic Asthma

Cited by 143 publications

References 16 publications

Effectiveness of Switching Biologics for Severe Asthma Patients in Japan: A Single-Center Retrospective Study

Effectiveness of Switching Biologics for Severe Asthma Patients in Japan: A Single-Center Retrospective Study

Effectiveness of mepolizumab therapy on symptoms, asthma exacerbations, steroid dependence, and small airways in patients with severe eosinophilic asthma

Mepolizumab Effectiveness and Allergic Status in Real Life

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