Efficacy and safety of anti-interleukin-5 therapy in patients with asthma: A pairwise and Bayesian network meta-analysis

Introduction: Anti-interleukin-5 therapy has been proposed as a novel and promising treatment option in asthma treatment. However, the optimum monoclonal antibodies for asthma treatment remain uncertain. Methods: We searched the PubMed, EMBASE and Cochrane databases from their inceptions to June 2018 for randomized controlled trials that reported pulmonary function, adverse events, Asthma Quality of Life Questionnaire (AQLQ) scores, and asthmatic exacerbations resulting from anti-interleukin-5 therapy in asthma patients. Extracted data were analyzed by pairwise and network meta-analysis. Results: Twenty-one randomized studies were identified for this analysis. By pairwise meta-analysis using a placebo as the reference, patients treated with monoclonal antibodies were associated with significantly improved forced expiratory volume (FEV1) values (standard mean difference [SMD], 0.18; 95% confidence interval [CI], 0.12-0.23; P < 0.001), lower rates of adverse events (risk ratio [RR], 0.93; 95% CI, 0.90-0.97; P < 0.001) and significant improvements in the AQLQ scores (SMD, 0.20; 95% CI, 0.13-0.26; P < 0.001). There were no significant differences in exacerbations risks (RR, 0.68; 95% CI, 0.11-4.14; P = 0.097). According to network meta-analysis, adverse events-related benefits were seen only with reslizumab, while AQLQ scores benefits, and pulmonary function benefits were still seen with all three monoclonal antibodies. The assessment of rank probabilities indicated that reslizumab presented the greatest likelihood of having benefits for pulmonary function, reducing adverse events and improving AQLQ scores when compared with the placebo, and mepolizumab presented the best benefits for reducing asthmatic exacerbations. Conclusions: Anti-interleukin-5 therapy appears to be a safe and effective treatment for asthma patients with respect to pulmonary lung function, adverse events and AQLQ scores, and do not increase asthmatic exacerbations. Our network meta-analysis in patients with asthma suggests that reducing adverse events benefits due to reslizumab, and pulmonary lung function benefits as well as good AQLQ scores are seen with respect to the three antibodies. Network meta-analysis indicates the probability that the best anti-interlukin-5 therapy for asthma patients might be reslizumab, but further trials are required to determine the most effective asthma treatment drug.