Reslizumab for Inadequately Controlled Asthma With Elevated Blood Eosinophil Levels

Bjermer, Leif; Lemière, Catherine; Máspero, Jorge; Weiss, Sagit; Zangrilli, James; Germinaro, Matthew

doi:10.1016/j.chest.2016.03.032

Cited by 380 publications

(286 citation statements)

References 24 publications

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“…The systematic literature search identified four randomised controlled trials which examined the efficacy of mepolizumab [22–25], and five trials (published in four papers) which examined the efficacy of reslizumab [26–28]. All studies had placebo as comparator.…”

Section: Resultsmentioning

confidence: 99%

“…Nine randomised trials of 3160 patients were included in the meta-analysis (four regarding mepolizumab [22–25], and five regarding reslizumab [26–29]). No studies presented the number of patients experiencing the MCID of 200 mL in forced expiratory volume (FEV1).…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies of 3165 patients were included; four mepolizumab studies (three using Asthma Control Questionnaire [ACQ]5 [22,23,25], and one ACQ6 [24]), and reslizumab studies (all used ACQ7 [26–29]). We pooled the results from the different ACQ versions in the meta-analysis and found a change of −0.29 points (95% CI −036; −0.23) in the anti-IL-5 group compared to placebo, which was below the minimal clinically important effect of 0.5 points (Figure 8).…”

Section: Resultsmentioning

confidence: 99%

“…We included four studies using the Asthma Quality of Life Questionnaire (AQLQ): one mepolizumab study [24] and three reslizumab studies [26,29]. Further three studies were included, which used SGRQ, in which the MCID is 4 points [22,23,25], which gave a total of 2562 included patients.…”

Section: Resultsmentioning

confidence: 99%

“…We included nine studies of 3201 patients (four regarding mepolizumab [22–25], and five regarding reslizumab [26–29]), and found a larger dropout rate in the placebo group compared to the anti-IL-5 group (relative risk reduction of 0.85 [95% CI 0.69; 1.05]). Recalculated to absolute values, we found −2.3%-point (95% CI −4.7;-0.7) difference in dropout in the anti-IL-5 group compared to the placebo group (Figure 10), which was below the MCID of 10%.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy, adverse events, and inter-drug comparison of mepolizumab and reslizumab anti-IL-5 treatments of severe asthma – a systematic review and meta-analysis

Henriksen

Bødtger

Sidenius³

et al. 2018

European Clinical Respiratory Journal

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Background: New, complex, and expensive therapies targeting Interleukin-5 (IL-5) to treat severe eosinophilic asthma are emerging.Objective: To assess efficacy, adverse events, and inter-drug comparison of mepolizumab and reslizumab for treating severe eosinophilic asthma.Design: A systematic review and meta-analysis on randomized, placebo-controlled, clinical trials elucidating two critical (exacerbation rate and oral corticosteroid (OCS) use) and six important clinical outcomes on the efficacy and safety of mepolizumab and reslizumab.Results: Five studies (N = 2197) contributed with data for exacerbation rate, showing a reduction of 53% (95% CI 46; 59) in favour of anti-IL-5, corresponding to –0.94 annual exacerbations (95% CI –1.08;–0.82), thus exceeding the predefined minimal clinical important difference (MCID) of 25% reduction of the estimated ≥2 annual exacerbations. Quality of evidence was considered moderate, with low heterogeneity in study findings (I2 = 0%). One study (N = 135) contributed with data on percentage of patients experiencing ≥50% reduction inoral corticosteroid treatment, showing an effect of 20% (95% CI 2.3;47) in favour of anti-IL-5 treatment (mepolizumab), thus exceeding the predefined MCID of 10%. Quality of evidence was considered low.Compared to placebo, anti-IL-5 showed significant improvements in lung function, asthma control, and asthma-related quality of life, but below the MCIDs. No differences were observed for serious adverse events and number of patients, who dropped out. No studies evaluating sickleave or head-to-head comparisons were identified. By indirect comparison, we found no significant difference between mepolizumab and reslizumab in any ofthe predefined clinical outcomes. OCS treatment reduction could not be compared due to lack of reslizumab studies investigating this outcome.Conclusions: Mepolizumab and reslizumab provide significant and clinically relevant improvements in exacerbation rate and OCS reduction. Indirect, inter-study comparisons revealed no differences between the anti-IL-5 drugs in efficacy or safety measures.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Efficacy, adverse events, and inter-drug comparison of mepolizumab and reslizumab anti-IL-5 treatments of severe asthma – a systematic review and meta-analysis

Henriksen

Bødtger

Sidenius³

et al. 2018

European Clinical Respiratory Journal

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Anti-IL5 therapies for asthma

Farne

Wilson

Powell

et al. 2017

Cochrane Database of Systematic Reviews

278

292

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Overall our study supports the use of anti-IL-5 treatments as an adjunct to standard of care in people with severe eosinophilic asthma and poor control. These treatments roughly halve the rate of asthma exacerbations in this population. There is limited evidence for improved HRQoL scores and lung function, which may not meet clinically detectable levels. There were no safety concerns regarding mepolizumab or reslizumab, and no excess serious adverse events with benralizumab, although there remains a question over adverse events significant enough to prompt discontinuation.Further research is needed on biomarkers for assessing treatment response, optimal duration and long-term effects of treatment, risk of relapse on withdrawal, non-eosinophilic patients, children (particularly under 12 years), and comparing anti-IL-5 treatments to each other and, in people eligible for both, to anti-immunoglobulin E. For benralizumab, future studies should closely monitor rates of adverse events prompting discontinuation.

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