Efficacy of mepolizumab for patients with severe asthma and eosinophilic chronic rhinosinusitis

Takanori Numata,Katsutoshi Nakayama,Hirofumi Utsumi,Kenji Kobayashi,Mitsuo Hashimoto,Kazuyoshi Kuwano,Takeo Ishikawa,Hiromichi Hara,Shunsuke Minagawa,Haruhiko Yanagisawa,Jun Araya

doi:10.1186/s12890-019-0952-1

Takanori Numata, Katsutoshi Nakayama + Show 9 more

Open Access

https://doi.org/10.1186/s12890-019-0952-1

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Abstract

BackgroundSeveral major randomized control studies have demonstrated that mepolizumab, an anti-IL-5 monoclonal antibody, is effective for patients with severe eosinophilic asthma who show exacerbation or require systemic corticosteroid maintenance therapy. However, the predictive factors of the response to mepolizumab other than blood eosinophil count are unclear in clinical practice.ObjectiveTo elucidate the predictive factors of the response to mepolizumab for patients with severe eosinophilic asthma.MethodsFrom July 2016 to December 2017, 28 patients with severe asthma received mepolizumab in our hospital. To determine the predictive factors, we retrospectively evaluated patient characteristics, comorbidities, biomarkers, pulmonary function, maintenance dose of systemic corticosteroids and number of exacerbations.ResultsThe response rate to mepolizumab treatment was 70% (19/27; one pregnant woman was excluded from analysis). Compared with 11 patients without eosinophilic chronic rhinosinusitis (ECRS), 16 patients with ECRS showed significantly improved systemic corticosteroid-sparing effects [− 71.3 ± 37.0% vs − 10.7 ± 20.1%, P = 0.006], change from baseline FeNO [− 19 ± 57 (%) vs 30 ± 77 (%), P = 0.023] and symptoms [14 patients (88%) vs five patients (45%), P = 0.033]. ECRS was identified as a predictive factor of the response to mepolizumab in a multivariate logistic regression analysis [odds ratio = 22.5, 95% CI (1.5–336), P = 0.024]. Of the eight patients previously administered omalizumab, five responded to mepolizumab. Staphylococcus aureus enterotoxin B IgE results were negative in 80% of responders (P = 0.14).ConclusionBoth groups showed improved symptom scores and a decreased number of exacerbations. Mepolizumab substantially improved the clinical variables of patients with eosinophilic asthma complicated with ECRS.

Highlights

It is estimated that as many as 300 million people of all ages and ethnic backgrounds suffer from asthma [1]
Mepolizumab substantially improved the clinical variables of patients with eosinophilic asthma complicated with eosinophilic chronic rhinosinusitis (ECRS)
Previous reports have demonstrated the efficacy of this treatment in patients with severe eosinophilic asthma, patients who meet the criteria of eosinophil counts do not always respond to mepolizumab

Summary

Introduction

It is estimated that as many as 300 million people of all ages and ethnic backgrounds suffer from asthma [1]. Several major randomized control trials (RCTs) have demonstrated that this antibody reduces the number of eosinophils in both sputum and blood, resulting in reductions in exacerbations, improvements in pulmonary function and a glucocorticoid-sparing effect in patients with uncontrolled asthma and a peripheral blood eosinophil count ≥150/mm at baseline or ≥ 300/mm during the previous year [11,12,13]. Previous reports have demonstrated the efficacy of this treatment in patients with severe eosinophilic asthma, patients who meet the criteria of eosinophil counts do not always respond to mepolizumab. Several major randomized control studies have demonstrated that mepolizumab, an anti-IL-5 monoclonal antibody, is effective for patients with severe eosinophilic asthma who show exacerbation or require systemic corticosteroid maintenance therapy. The predictive factors of the response to mepolizumab other than blood eosinophil count are unclear in clinical practice

Methods

Results

Conclusion