Severe Asthma Remissions Induced by Biologics Targeting IL5/IL5r: Results from a Multicenter Real-Life Study

Maglio, Angelantonio; Vitale, Carolina; Pelaia, Corrado; D’Amato, Maria; Ciampo, Luigi; Sferra, Eliana; Molino, Antonio; Pelaia, Giulia; Vatrella, Alessandro

doi:10.3390/ijms24032455

Cited by 24 publications

(20 citation statements)

References 29 publications

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“…20,21 Whilst a smaller sample size, the data presented in an Italian comparative study also suggests that benralizumab is more effective than mepolizumab in improving exacerbation frequency and FEV 1 . 22 In all these reports, just as in our study, the eosinophil depletion was significantly greater with benralizumab than mepolizumab. Benralizumab has also been used with success in patients who have experienced a suboptimal response to mepolizumab.…”

Section: Discussionsupporting

confidence: 81%

Benralizumab and mepolizumab treatment outcomes in two severe asthma clinics

Langton,

Politis,

Collyer

et al. 2023

Respirology

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Background and ObjectiveThis study compared the clinical outcomes of severe asthmatics treated with mepolizumab and benralizumab in a tertiary care severe asthma service setting.MethodsPatient data at baseline, six and 12 months were collected prospectively at two large tertiary hospital severe asthma clinics following treatment initiation. Two hundred and four patients received treatment with mepolizumab (117) or benralizumab (87). Baseline characteristics between groups were similar in regard to age, gender, body mass index, steroid dose and blood eosinophil count. However, the mepolizumab cohort had a higher Asthma Control Questionnaire Score (ACQ) at baseline (4.0 ± 1.1 vs. 3.6 ± 0.9, p = 0.018), accompanied by more frequent reliever medication usage and lower prebronchodilator FEV1% (56.0 ± 20.1 vs. 63.8 ± 18.9, p = 0.008).ResultsAfter 6 months treatment, both treatments induced significant improvements in (i) ACQ of 2.3 ± 0.1 (p < 0.001), (ii) oral steroid requiring exacerbations (incident rate ratio 0.26 (0.18–0.37), p < 0.001) and (iii) FEV1. However, the improvement in FEV1 was 0.18 (0.05–0.30) litres greater with benralizumab than with mepolizumab (p = 0.002) even when adjusting statistically for baseline differences between groups. These differences were even more pronounced at 12 months post‐treatment initiation, when the improvement in exacerbation frequency with benralizumab was 64% greater than with mepolizumab (p = 0.01). Whilst both treatments significantly reduced the blood eosinophil count at 6 and 12 months, this reduction was substantially greater with benralizumab than mepolizumab (−260 cells/μL [−400 to −110, p = 0.001]).ConclusionIn this large group of severe eosinophilic asthmatics, mepolizumab and benralizumab both improved disease parameters. However, benralizumab treatment appeared significantly more effective than mepolizumab in reducing exacerbations, improving FEV1 and depleting blood eosinophils.

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Section: Discussionsupporting

confidence: 81%

Benralizumab and mepolizumab treatment outcomes in two severe asthma clinics

Langton,

Politis,

Collyer

et al. 2023

Respirology

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“…In our analysis, we have taken the ambitious definition of achieving ≥80% predicted post-bronchodilator FEV 1 as our reflection of optimization of lung function, as this is what could be classified as within the normal range. A recently published (2023) observational multicenter retrospective study by Maglio et al ( 13 ), also used ≥80% predicted post-bronchodilator FEV 1, alongside OCS-free, exacerbation-free and ACT score ≥20, aligning with our four-component definition of remission. In their study, in 83 patients with severe asthma treated with mepolizumab for 12 months, they reported the same proportion of patients (30%) achieving remission as reported here using our four-way definition.…”

Section: Discussionmentioning

confidence: 99%

Remission outcomes in severe eosinophilic asthma with mepolizumab therapy: Analysis of the REDES study

Pavord

Gardiner²,

Heaney

et al. 2023

Front. Immunol.

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IntroductionClinical remission as a multicomponent treatment goal in severe asthma is being explored in clinical practice. This post hoc analysis used data from the REDES study to assess the proportion of patients with severe eosinophilic asthma achieving our multicomponent definitions of clinical remission after 1 year of mepolizumab treatment.MethodsThe real-world, retrospective observational REDES study enrolled patients with severe eosinophilic asthma who were newly prescribed mepolizumab and with ≥12 months of medical records pre-enrolment. Multicomponent clinical remission was defined as: oral corticosteroid (OCS)-free; exacerbation-free; asthma control test (ACT) score ≥20; and with or without post-bronchodilator forced expiratory volume in 1 second ≥80%. Baseline characteristics were also assessed in those who did/did not achieve clinical remission.Results37% and 30% of patients with severe eosinophilic asthma met our proposed three- and four-component on-treatment clinical remission definitions; an increase from 2% and 3% at baseline. Most frequently achieved individual components of clinical remission were: OCS-free; ACT score ≥20. For patients fulfilling the multicomponent clinical remission definitions, at baseline we observed higher blood eosinophil counts, better ACT scores and lung function, lower maintenance OCS use, and a slightly lower rate of prior exacerbations versus those who did not.DiscussionClinical remission is a realistic target in clinical practice for a subset of patients with severe eosinophilic asthma receiving mepolizumab. Further studies are required to elucidate whether features linked to the underlying endotype can help predict treatment outcomes, increase rates of clinical remission, and potentially modify disease progression.

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“… 7 The percentage of remissions has been shown to reach approximately 30% after 1 year in patients treated with mepolizumab. 8 , 9 The characteristics of patients successfully discontinuing mepolizumab have been shown to have fewer asthma symptoms, well‐controlled asthma comorbidities and suppressed type 2 inflammation, such as lower blood eosinophil counts and/or FeNO levels, during the treatment of mepolizumab. 10 Further, Hamada K et al present two cases of severe eosinophilic asthma withdrawing the treatment of benralizumab, anti‐IL‐5R antibody.…”

Section: Discussionmentioning

confidence: 99%

“…Actually, the addition of biologics achieves multiple criteria for asthma remission on treatment 7 . The percentage of remissions has been shown to reach approximately 30% after 1 year in patients treated with mepolizumab 8,9 . The characteristics of patients successfully discontinuing mepolizumab have been shown to have fewer asthma symptoms, well‐controlled asthma comorbidities and suppressed type 2 inflammation, such as lower blood eosinophil counts and/or FeNO levels, during the treatment of mepolizumab 10 .…”

Section: Discussionmentioning

confidence: 99%

Severe asthma remaining well‐controlled after mepolizumab discontinuation: A case report and literature review

Matsuyama

Tomioka

Matsuyama

et al. 2023

Respirology Case Reports

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Mepolizumab, a humanized anti‐IL‐5 monoclonal antibody used for severe asthma, results in a reduced rate of asthma exacerbation, improved lung function, reduced oral corticosteroid use, and improved quality of life. A 62‐year‐old man using high‐dose inhaled corticosteroid visited our hospital because of poorly‐controlled asthma. He had eosinophilia in peripheral blood and sputum, and high levels of fraction of exhaled nitric oxide. Therefore, he was treated with mepolizumab for severe asthma. Mepolizumab treatment resulted in significantly improved pulmonary function and reduced frequencies of asthma exacerbations. Because of his good asthma control, mepolizumab treatment was discontinued after 3 years. Since discontinuing mepolizumab, his asthma control has remained without exacerbation. Previous studies suggest that mepolizumab should be continued to sustain clinical benefits. However, cases of long‐term controlled asthma have not been reported after mepolizumab withdrawal, and our case may be instructive.

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Severe Asthma Remissions Induced by Biologics Targeting IL5/IL5r: Results from a Multicenter Real-Life Study

Cited by 24 publications

References 29 publications

Benralizumab and mepolizumab treatment outcomes in two severe asthma clinics

Benralizumab and mepolizumab treatment outcomes in two severe asthma clinics

Remission outcomes in severe eosinophilic asthma with mepolizumab therapy: Analysis of the REDES study

Severe asthma remaining well‐controlled after mepolizumab discontinuation: A case report and literature review

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