Early treatment response may predict long-term mepolizumab benefit in severe asthma

Nieuwe ontwikkelingen in diagnostiek en monitoring (Nederlands)

Hans Kroes
Medisch Centrum Leeuwarden, Klinische Farmacie en Farmocologie
Background: Mepolizumab treatment improves asthma outcomes in the majority but not all patients with severe eosinophilic asthma. Baseline patient characteristics may influence mepolizumab induced outcomes, but it is difficult to assess individuals’ chance of being a responder. Assessment of early treatment response may add in the prediction of long-term benefit.
Aim: To examine the relationship between mepolizumab induced asthma control at 8 weeks and the chance of being mepolizumab responder at 32 weeks.
Methods: 20 severe asthma patients that started with mepolizumab were evaluated on baseline and 8, 16 and 32 weeks. We compared therapy response, defined as continuing mepolizumab therapy at 32 weeks, in patients with and without good asthma control (ACQ≤0.75) at 8 weeks.
Results: Of the 20 included patients (median age 52 years (range 28-76), 50% male, 70% OCS dependent), 16 patients (80%) continued mepolizumab therapy at 32 weeks after initiation (responders). Median ACQ decreased from 2.42 (0.67–4.33) at baseline to 0.75 (0.0-3.33) after 8 weeks of therapy (p<0.001), despite median OCS dose decreasing from 7.5 (0-20) to 5 mg/day (0-20) (p=0.037). 10 out of 20 patients (50%) had good asthma control at 8 weeks (ACQ≤0.75) and came out as mepolizumab responder at 32 weeks (positive predictive value =100%), versus 6/10 patients with ACQ>0.75 at 8 weeks(negative predictive value=40%)(RR 1.7, 95%CI 1.005-2.765; P=0.043).
Conclusions: Patients who show good asthma control at 8 weeks of mepolizumab treatment have a very high chance of therapy response at 32 weeks. These data suggest that early treatment responses may be
helpful to identify patients that benefit from biologicals in the long-term.
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