Efficacy and safety of mepolizumab in a real-world cohort of patients with severe eosinophilic asthma

Background: The interleukin 5 (IL-5) pathway is an important component in the pathophysiology of severe eosinophilic asthma. Mepolizumab is a monoclonal antibody that targets the IL-5 pathway. Clinical trials showed efficacy of Mepolizumab in patients with severe eosinophilic asthma. However, reports on experience with treatment in a real-world cohort are limited. Objectives: Evaluation of the efficacy and safety of Mepolizumab for treatment of severe eosinophilic asthma in a real-world cohort of patients. Methods: A clinical prospective observational trial included all patients >18 years treated with Mepolizumab between March 2016 to March 2019 at Rabin Medical Center. The composite primary outcome measures evaluated: increase in FEV1 by >= 200 ml and/or decrease in exacerbation rate of >= 50% and/or cessation of oral corticosteroids (OCS) treatment or >= 50% decrease in dosage. Also evaluated: blood eosinophil count, adverse events and quality of life. Results: Of 61 patients, 50 (82.0%) achieved the primary outcome. The number of patients who suffered from frequent exacerbations decreased from 52 (85.2%) to 8 (13.1%) (p < 0.001). Twenty-two patients (68%) stopped OCS treatment or received >50% reduced dosage (p < 0.001). Mean FEV1 increased from 1.72 +/- 0.78 liters to 1.87 +/- 0.85 liters (p = 0.043). Response to therapy was seen within six months. Forty-nine patients (80%) reported an improvement in quality of life (p < 0.001). Only minor adverse events were reported. Conclusion: Treatment with mepolizumab was well tolerated and significantly lowered the exacerbation rate and OCS dependence in a real-world cohort of severe eosinophilic asthma patients. Response to therapy was within six months and treatment effect was sustained over time.

Automated summary

The study evaluated the effectiveness and safety of Mepolizumab treatment for severe eosinophilic asthma in a real-world setting. More than 80% of patients achieved the primary outcomes, with improvements in peak expiratory flow rate, reduced exacerbation frequency, and some stopping or decreasing oral corticosteroid treatment.