Mepolizumab beneficial for patients with severe eosinophilic asthma 

In patients with severe eosinophilic asthma, continued reductions in clinically significant exacerbations were reported with the administration of mepolizumab after 2 years of follow-up. The current, real-world study confirmed the benefits of this IL-5 inhibitor in everyday practice.

The prospective, observational, single-arm REALITI-A study investigated the real-world benefits of mepolizumab in patients with severe eosinophilic asthma (n=823). Participants received 12 months of pre-treatment prior to enrolment, consisting of standard-of-care plus mepolizumab, and were subsequently followed for 24 months. Outcomes included the rate of clinically significant exacerbations, the use of maintenance oral corticosteroids (OCS), and exacerbations leading to hospital or emergency department admissions. The results after 1 year of follow-up were reported previously [1]. Dr Rupert Jakes (GSK, UK) presented the trial results after an additional 12 months of follow-up [2].

After 2 years of follow-up, 73% of the study population still received mepolizumab. Of those who had discontinued the study drug, 9% did this because of a perceived lack of efficacy. The clinical benefits of mepolizumab that had been reported after 1 year of follow-up were maintained after 2 years of follow-up. Compared with the pre-treatment period, the rate of clinically significant exacerbations (rate ratio 0.26; P<0.001) and the rate of exacerbations requiring hospitalisations or emergency department visits (rate ratio 0.21; P<0.001) were reduced significantly. Moreover, a 100% reduction in the daily median maintenance OCS dose was recorded at 2 years of follow-up; 57% of the participants using maintenance OCS at baseline had discontinued this therapy by week 101–104. According to Dr Jakes, no unexpected safety issues were observed.

In total, 90 treatment-related adverse events were reported, of which 18 led to the discontinuation of the study drug. One of the 7 treatment-related serious adverse events, a case of diffuse liver malignancy, resulted in the death of a patient.

Overall, the 2-year follow-up results of the REALITI-A trial confirmed the clinical benefits of mepolizumab in patients with severe eosinophilic asthma.

1. Pilette C, et al. J Allergy Clin Immunol Pract. 2022;S2213–2198(22)00629–8.
2. Jakes R, et International, prospective study of mepolizumab in severe asthma: REALITI-A at 2 years. TP-26, ERS Congress 2022, ERS International Congress 2022, Barcelona, Spain, 4–6 September.

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Posted on 30 October 202229 February 2024