Bronchial thermoplasty versus mepolizumab: Comparison of outcomes in a severe asthma clinic

Background and objective BT and interleukin-blocking monoclonal antibodies are both effective therapies for severe asthma, but there have been no direct comparisons between the two treatments. The aim of this study was to compare the efficacy and safety of BT and mepolizumab, in a real-world setting. Methods Patients with severe asthma despite optimized inhaler therapy were drawn from a severe asthma clinic in a tertiary hospital. Every patient commencing therapy with BT or mepolizumab was prospectively included in a national registry. At predetermined assessment points over a 12-month period, assessments were made of ACQ, spirometry, oral corticosteroid requiring exacerbations, reliever medication and maintenance oral corticosteroid use. Results A total of 91 patients with severe asthma participated: mean ACQ score 3.5 +/- 1.0, FEV1 51.4 +/- 17.7%, maintenance oral steroids 48.3% and 11.5 +/- 10.0 inhalations/day reliever therapy. Forty-seven patients received mepolizumab and 44 received BT. Baseline characteristics were similar except significantly higher blood eosinophil count in the mepolizumab group. At 12 months, there were no differences between treatment outcomes for ACQ (1.9 +/- 1.3 mepolizumab vs 1.7 +/- 1.3 BT), exacerbation rate (0.9 +/- 1.1 vs 0.9 +/- 1.5), reduction in reliever use (-6.3 +/- 10.5 vs -5.0 +/- 8.8 puffs/day) or reduction in oral corticosteroids (-3.3 +/- 7.5 vs - 5.8 +/- 6.7 mg/day). The FEV1 improved equally (160 +/- 290 vs 150 +/- 460 mL). Readmission or prolonged admission was observed in 18.2% of BT patients, whilst 25.5% of mepolizumab patients had discontinued treatment at 12 months, 14.9% due to an adverse event or non-compliance. Conclusion The results suggest that BT is as efficacious as mepolizumab for the treatment of severe asthma.