Real-world study affirms benefit of mepolizumab in severe eosinophilic asthma

Interleukin 5 (IL-5) inhibition with mepolizumab appears to improve asthma control, cutting the incidences of exacerbations and hospitalizations, in patients with severe eosinophilic asthma treated in a real-world setting, a study reports.

Researchers searched multiple online databases for real-world studies looking into severe asthma treatment with mepolizumab. Effectiveness was assessed using indicators such as exacerbations, asthma-related hospitalizations, forced expiratory volume in 1 second (FEV1), Asthma Control Questionnaire (ACQ) or Asthma Control Test (ACT), corticosteroid use, peripheral blood eosinophil counts, and the fraction of exhaled nitric oxide.

Effect size estimates were obtained using the Cohen method, with d values of 0.2, 0.5, and 0.8 indicating small, medium, and large effects, respectively. The Dersimonian-Laird random-effect model was used to quantify pooled effectiveness estimates.

The analysis included 13 studies with a total of 1,457 patients. At all time points, mepolizumab cut the incidences of exacerbations (2.92 and 2.73 events per patient per year fewer at 6 and 12 months, respectively) and hospitalizations (0.36 events per patient per year fewer at 12 months).

Treatment also yielded improvements in asthma control (ACQ scores reductions of 1.32 and 1.03 at 6 and 12 months, respectively; ACT scores increase of 6.52 at 6–12 months) and pulmonary function (FEV1 increase of 0.23 L at 1–3 months and 6–12 months, respectively).

Oral corticosteroid use requirement decreased by 9.02 mg at 6 months and by 7.68 mg at 12 months. Peripheral blood eosinophil counts fell by 559.11 cells/μL at 1–3 months and by 599.17 cells/μL at 6–12 months. Finally, there was a reduction of 13-ppb in fraction of exhaled nitric oxide at 6–12 months.

The findings serve as a supplement to and extension of the efficacy of randomized controlled trials of mepolizumab.