Mepolizumab in real-life treatment of severe eosinophilic asthma

Abstract

Background: Mepolizumab is a humanized monoclonal antibody targetig interleukin‐5, used as add-on therapy for patients with uncontrolled severe eosinophilic asthma, aged ≥12 years. Aim: To evaluate real-life effect of mepolizumab to exacerbations, use of oral corticosteroids (OCS) and lung functions in patients with severe eosinophilic asthma. Methods: All adult patients with severe eosinophilic asthma in tertiary referral center, with more than 300 eosinophil cells/μL of peripheral blood and with ≥ 4 exacerbations (treated by systemic corticosteroids) or maintenance OCS treatment least 6 months were indicated to mepolizumab treatment between November 2018 - January 2019. They were evaluated at the baseline and after 12 months. Lung functions, count of eosinophils in blood, exacerbation frequency and OCS use were evaluated. Results: A total of 17 patients (10 males) were analysed. Baseline mean age was 58 (42 to 71) years, mean body mass index 27.2 (17 – 37), mean blood eosinophil count 642 (330 to 1170) cells/μL. After mepolizumab treatment mean blood eosinophil count decreased to 65 (10 to 130) cells/μL, number of exacerbation in 12 months period decreased from 4.4 (2 to 11) to 0.7 (0 to 2), daily dose of maintenance OCS treatment (among 11 patients) was reduced from 11.8 mg (5 to 25 mg) to 3.0 mg (0 to 10 mg) of prednisolone, OCS were withdrawn in 6 of the patients. Lung functions were improved in 15 patients. Comorbidities in all patients were evaluated. The most frequent were gastroesophageal reflux and rhinosinusitis with nasal polyposis. Conclusion: Our experience confirms effect of mepolizumab treatment to improving of astma control and reducing of OCS use in real-life severe eosinophilic astma patients.