A study being presented at the CHEST Annual Meeting 2019 found that mepolizumab reduced exacerbations in patients with severe eosinophilic asthma, regardless of baseline oral corticosteroid (OCS) use.
The previously reported SIRIUS clinical trial demonstrated that mepolizumab had a significant glucocorticoid-sparing effect and reduced exacerbations in patients with severe eosinophilic asthma receiving maintenance OCS.
In this post-hoc subgroup meta-analysis of patients in the MENSA and MUSCA studies, researchers assessed the annual rate of clinically significant exacerbations (defined as requiring administration of systemic glucocorticoids for three or more days or an emergency department [ED] visit and hospitalization) in patients receiving mepolizumab 100 mg subcutaneously or placebo. Exacerbations were assessed at week 32 in the MENSA study and week 24 in the MUSCA study.
A total of 936 patients were included: 227 (24%) had used maintenance OCS and 709 (76%) had not. Among patients receiving maintenance OCS, the median dose was 10 mg daily. Maintenance OCS was associated with a greater disease burden, higher mean St. George’s Respiratory Questionnaire total score (using OCS, 52.9; not using OCS, 45.2), higher mean Asthma Control Questionnaire-5 score (using OCS, 2.44; not using OCS, 2.16), and greater number of exacerbations requiring hospitalization or an ED visit (using OCS, n=87/227 [38%]; not using OCS, n=221/709 [31%]).
All patients achieved a clinically meaningful reduction in exacerbation rate with mepolizumab compared with placebo. A numerically higher exacerbation reduction was observed in patients not receiving maintenance OCS (rate ratio for mepolizumab/placebo: using OCS, 0.66 [95% CI, 0.47 to 0.93] vs. not using OCS, 0.37 [95% CI, 0.28 to 0.48]).
Smith S, Lugogo N, Pavord I, et al. Mepolizumab reduces exacerbations in patients with severe eosinophilic asthma irrespective of baseline maintenance OCS use: meta-analysis from two Ph3 trials. Presented at the CHEST Annual Meeting 2019. October 19-23, 2019; New Orleans, Louisiana.