[en] [en] BACKGROUND: Some patients with severe asthma have overlapping allergic and eosinophilic phenotypes and may be eligible for anti-eosinophilic or anti-immunoglobin E (IgE) biologics.
OBJECTIVE: This post hoc sub-analysis assessed real-world mepolizumab effectiveness in patients with overlapping allergic and eosinophilic phenotypes, using 1-year data from the international, prospective REALITI-A (REAL world effectiveness of mepolizumab In paTIent care - Asthma) study.
METHODS: The clinically significant asthma exacerbations (CSE) rate was assessed 1 year before (pretreatment) and after (follow-up) mepolizumab treatment, stratified by baseline total IgE (tIgE) levels (<60, 60 to <190, 190 to <550, and ≥550 kilounits per litre [kU/L]), atopic status (yes/no/unknown), previous omalizumab use (yes/no), geographic baseline omalizumab eligibility (eligible/non-eligible), and baseline tIgE level and blood eosinophil count threshold combinations (<81 or ≥81 kU/L and <300 or ≥300 cells per microliter [cells/μL]).
RESULTS: Overall, 822 patients were included. CSEs occurred in 760 patients (93%) pretreatment and 398 patients (49%) during follow-up. CSE rate (rate ratio [95% CI]) was reduced in follow-up across all tIgE subgroups (<60 [n = 173]: 0.31 [0.25-0.37]; 60 to <190 [n = 176]: 0.30 [0.25-0.36]; 190 to <550 [n = 170]: 0.26 [0.20-0.33]; ≥550 kU/L [n = 155]: 0.28 [0.23-0.35]) and irrespective of atopic status (yes [n = 422]: 0.29 [0.26-0.33]; no [n = 52]: 0.33 [0.23-0.47]; unknown [n = 348]: 0.28 [0.24-0.32]), previous omalizumab use (yes [n = 151]: 0.37 [0.30-0.45]; no [n = 671]: 0.27 [0.24-0.30]), or eligibility (eligible [n = 349]: 0.29 [0.25-0.34]; non-eligible [n = 191]: 0.32 [0.27-0.38]). Furthermore, the CSE rate was reduced across all tIgE (kU/L) and blood eosinophil count (cells/μL) combinations (<81/<300 [n = 53]: 0.34 [0.24-0.47]; <81/≥300 [n = 103]: 0.33 [0.26-0.41]; ≥81/<300 [n = 98]: 0.36 [0.28-0.47]; ≥81/≥300 [n = 249]: 0.26 [0.22-0.31]).
CONCLUSION: Mepolizumab demonstrates real-world effectiveness in reducing exacerbations in patients with severe asthma and an eosinophilic phenotype, regardless of any overlapping allergic phenotype.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Lee, Jason K; Toronto Allergists, Evidence Based Medical Educator, Toronto, Ontario, Canada
Pollard, Stephen J; Family Allergy and Asthma Research Institute, Louisville, Kentucky, USA
Liu, Mark C; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
Schleich, Florence ; Université de Liège - ULiège > Département des Sciences de l'activité physique et de la réadaptation > Physiologie humaine et physiologie de l'effort physique
Pelaia, Girolamo; Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
Almonacid, Carlos; Pneumology Department, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
Heaney, Liam G; Wellcome-Wolfson Centre for Experimental Medicine, Queens University Belfast, Belfast, United Kingdom
Chaudhuri, Rekha; Asthma/COPD Clinical Research Centre, Gartnavel General Hospital, Glasgow, United Kingdom, School of Infection & Immunity, University of Glasgow, Glasgow, United Kingdom
Alfonso-Cristancho, Rafael; Global Real-World Evidence and Health Outcomes Research, GSK, Collegeville, Pennsylvania, USA
Zhang, Lingjiao; Biostatistics, GSK, Collegeville, Pennsylvania, USA
Maxwell, Aoife; Non-Interventional Study Delivery & Planning, Global Clinical Operations, GSK, Stevenage, Hertfordshire, United Kingdom
Howarth, Peter ; Global Medical Affairs, Specialty Care, GSK, London, United Kingdom. Electronic address: peter.h.howarth@gsk.com
Language :
English
Title :
Mepolizumab real-world effectiveness in severe asthma with an eosinophilic phenotype and overlapping severe allergic asthma.
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