Mepolizumab and oral corticosteroid stewardship: data from the Australian Mepolizumab Registry

Dennis Thomas, Erin S. Harvey, Vanessa M. McDonald, Sean Stevens, John W. Upham, Constance H. Katelaris, Vicky Kritikos, Andrew Gillman, John Harrington, Mark Hew, Philip Bardin, Matthew Peters, Paul N. Reynolds, David Langton, Melissa Baraket, Jeffrey J. Bowden, Simon Bowler, Jimmy Chien, Li Ping Chung, Claude S. FarahChristopher Grainge, Christine Jenkins, Gregory P. Katsoulotos, Joy Lee, Naghmeh Radhakrishna, Helen K. Reddel, Janet Rimmer, Pathmanathan Sivakumaran, Peter A. B. Wark, Peter G. Gibson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: Oral corticosteroids (OCS) carry serious health risks. Innovative treatment options are required to reduce excessive exposure and promote OCS stewardship. Objectives: This study evaluated the trajectories of OCS exposure (prednisolone-equivalent) in patients with severe eosinophilic asthma before and after starting mepolizumab and the predictors of becoming OCS free after 6 months of mepolizumab therapy. Methods: This real-world observational study included 309 patients from the Australian Mepolizumab Registry who were followed up for 1 year (n = 225). Results: Patients had a median age of 60 (interquartile range: 50, 68) years, and 58% were female. At baseline, 48% used maintenance OCS, 96% had ≥1 OCS burst, and 68% had received ≥1 g of OCS in the previous year. After commencing mepolizumab, only 55% of those initially on maintenance OCS remained on this treatment by 12 months. Maintenance OCS dose reduced from median 10 (5.0, 12.5) mg/day at baseline to 2 (0, 7.0) mg/day at 12 months (P < .001). Likewise, proportions of patients receiving OCS bursts in the previous year reduced from 96% at baseline to 50% at 12 months (P < .001). Overall, 137 (48%) patients required OCS (maintenance/burst) after 6 months' mepolizumab therapy. Becoming OCS free was predicted by a lower body mass index (odds ratio: 0.925; 95% confidence interval: 0.872-0.981), late-onset asthma (1.027; 1.006-1.048), a lower Asthma Control Test score (1.111; 0.011-1.220), and not receiving maintenance OCS therapy at baseline (0.095; 0.040-0.227). Conclusion: Mepolizumab led to a significant and sustained reduction in OCS dependence in patients with severe eosinophilic asthma. This study supports the OCS-sparing effect of mepolizumab and highlights the pivotal role of mepolizumab in OCS stewardship initiatives.

Original languageEnglish
Pages (from-to)2715-2724.e5
Number of pages15
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume9
Issue number7
DOIs
Publication statusPublished - Jul 2021
Externally publishedYes

Keywords

  • Mepolizumab
  • Observational study
  • OCS stewardship
  • Oral corticosteroid
  • Severe eosinophilic asthma

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