Efficacy of mepolizumab treatment in oral corticosteroid-dependent severe eosinophilic asthma patients with chronic rhinosinusitis with nasal polyps: single center, real life study
Efficacy of mepolizumab treatment in oral corticosteroid-dependent severe eosinophilic asthma patients with chronic rhinosinusitis with nasal polyps: single center, real life study
Background/aim: Oral corticosteroid (OCS)-dependent severe eosinophilic asthma with chronic rhinosinusitis with nasal polyps (SEACRSwNP)would be a suitable phenotype for mepolizumab treatment. This study evaluated the short-term efficacy of mepolizumabtreatment in OCS-dependent SEA-CRSwNP.Materials and methods: Baseline and 24th week results [daily OCS doses, asthma exacerbation frequency, asthma control test (ACT)scores, blood eosinophil levels, FEV1 values, and numerical analog scale (NAS) of CRSwNP symptoms] of patients who were treated forat least 24 weeks with mepolizumab were retrospectively evaluated and compared.Results: A total of 16 patients were enrolled in the study. Mepolizumab was discontinued in one patient due to side effects. The dailyOCS dosage was reduced from baseline in all patients, and at week 24 OCS was discontinued in 40% of the patients (baseline meansteroid dose: 9.2 ± 5.2 mg, 24th week: 1.3 ± 1.4 mg; P < 0.001). The number of asthma exacerbations within 24 weeks significantlydecreased after beginning mepolizumab treatment (2.1 ± 2.7 vs. 0.07 ± 0.26; P = 0.012), and a significant increase in ACT scores(baseline mean ACT: 18 ± 5.7; 24th week mean ACT: 23.3 ± 3; P = 0.006) was observed despite the decrease in daily OCS dosages. Therewas no significant difference in FEV1 values between baseline and week 24. Evaluation of the general symptoms of CRSwNP, as per NAS,revealed that the baseline mean NAS was 5.6 ± 4.4, and the 24th week mean NAS was 3.2 ± 3.2 (P = 0.021).Conclusion: This is the first real-life study evaluating the short-term efficacy of mepolizumab treatment on OCS-dependent SEACRSwNP.This study demonstrates that mepolizumab is an effective and safe biologic for the treatment of this severe asthma subphenotype.
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- 1. Flood-Page P, Swenson C, Faiferman I, Matthews J, Williams
M et al. International mepolizumab study group. A study to
evaluate safety and efficacy of mepolizumab in patients with
moderate persistent asthma. American Journal of Respiratory
and Critical Care Medicine 2007; 176: 1062-1071.
- 2. Leckie MJ, ten Brinke A, Khan J, Diamant Z, O’Connor BJ et
al. Effects of an interleukin-5 blocking monoclonal antibody
on eosinophils, airway hyperresponsiveness, and the late
asthmatic response. Lancet 2000; 356 (9248): 2144-2148.
- 3. Bel EH, Wenzel SE, Thompson PJ, Prazma CM, Keene ON
et al. Oral glucocorticoid-sparing effect of mepolizumab in
eosinophilic asthma. New England Journal of Medicine 2014;
371: 1189-1197.
- 4. Pavord ID, Korn S, Howarth P, Bleecker ER, Buhl R et al.
Mepolizumab for severe eosinophilic asthma (DREAM): a
multicentre, double-blind, placebo-controlled trial. Lancet
2012; 380: 651-659.
- 5. Ortega HG, Liu MC, Pavord ID, Brusselle GG, FitzGerald JM et
al. Mepolizumab treatment in patients with severe eosinophilic
asthma. New England Journal of Medicine 2014; 371: 1198-
1207.
- 6. Bousquet J, Chanez P, Lacoste JY, Barnéon G, Ghavanian N et
al. Eosinophilic inflammation in asthma. New England Journal
of Medicine 1990; 323(15): 1033-1039.
- 7. Amelink M, de Groot JC, de Nijs SB, Lutter R, Zwinderman
AH et al. Severe adult-onset asthma: a distinct phenotype.
Journal of Allergy and Clinical Immunology 2013; 132: 336-341.
- 8. Fajt ML, Wenzel SE. Asthma phenotypes and the use of
biologic medications in asthma and allergic disease: the next
steps toward personalized care. Journal of Allergy and Clinical
Immunology 2015; 135: 299-310.
- 9. de Groot JC, ten Brinke A, Bel EHD. Management of the
patient with eosinophilic asthma: a new era begins. European
Respiratory Journal Open Research 2015; 1: 00024-02015.
- 10. Moore WC, Meyers DA, Wenzel SE, Teague WG, Li H et al.
Identification of asthma phenotypes using cluster analysis
in the severe asthma research program. American Journal of
Respiratory and Critical Care Medicine 2010; 181 (4): 315-323.
- 11. Yilmaz İ, TerI M. Asthma management: a new phenotype
based approach using presence of eosinophilia and allergy.
Allergy 2017; 72 (10): 1587-1589.
- 12. Yılmaz İ, Turk M, Bahcecioglu SN. Eosinophilic asthma with
nasal polyposis march: is aspirin-exacerbated respiratory
disease the last station? Journal of Allergy and Clinical
Immunology: In Practice 2017; 5 (6): 1808-1809.
- 13. Licari A, Brambilla I, De Filippo M, Poddighe D, Castagnoli R
et al. The role of upper airway pathology as a co-morbidity in
severe asthma. Expert Review of Respiratory Medicine 2017; 11:
855-865.
- 14. Morita H, Moro K, Koyasu S. Innate lymphoid cells in allergic
and non-allergic inflammation. Journal of Allergy and Clinical
Immunology 2016; 138: 1253-1264.
- 15. Drick N, Seeliger B, Welte T, Fuge J, Suhling H. Anti-IL-5
therapy in patients with severe eosinophilic asthma—clinical
efficacy and possible criteria for treatment response. BMC
Pulmonary Medicine 2018; 18(1): 119.
- 16. Kurosawa M, Sutoh E. Prospective open-label study of 48-
week subcutaneous administration of mepolizumab in
Japanese patients with severe eosinophilic asthma. Journal of
Investigational Allergology and Clinical Immunology 2019;
29(1): 40-45.
- 17. Meltzer EO, Hamilos DL. Rhinosinusitis diagnosis and
management for the clinician: a synopsis of recent consensus
guidelines. Mayo Clinic Proceedings 2011; 86 (5): 427-443.
- 18. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I et al. EPOS
2012; European position paper on rhinosinusitis and nasal
polyps. A summary for otorhinolaryngologists. Rhinology
2012; 50 (1): 1-12.
- 19. Bachert C, Wagenmann M, Hauser U, Rudack C. IL-5 synthesis
is upregulated in human nasal polyp tissue. Journal of Allergy
and Clinical Immunology 1997; 99: 837-842.
- 20. Zhang N, Van Zele T, Perez-Novo C, Van Bruaene N, Holtappels
G et al. Different types of T-effector cells orchestrate mucosal
inflammation in chronic sinus disease. Journal of Allergy and
Clinical Immunology 2008; 122: 961-968.
- 21. Tomassen P, Vandeplas G, Van Zele T, Cardell LO, Arebro J et
al. Inflammatory endotypes of chronic rhinosinusitis based on
cluster analysis of biomarkers. Journal of Allergy and Clinical
Immunology 2016; 137 (5): 1449-1456.
- 22. Bachert C, Zhang N, Holtappels G, De Lobel L, van
Cauwenberge P et al. Presence of IL-5 protein and IgE
antibodies to staphylococcal enterotoxins in nasal polyps
is associated with comorbid asthma. Journal of Allergy and
Clinical Immunology 2010; 126: 962-968.
- 23. Van Zele T, Holtappels G, Gevaert P, Bachert C. Differences
in initial immuneprofiles between recurrent and nonrecurrent
chronic rhinosinusitis with nasal polyps. American Journal of
Rhinology & Allergy 2014; 28: 192-198.
- 24. Nair P, Pizzichini MM, Kjarsgaard M, Inman MD, Efthimiadis
A et al. Mepolizumab for prednisonedependent asthma with
sputum eosinophilia. New England Journal of Medicine 2009;
360: 985-993.
- 25. Bachert C, Sousa AR, Lund VJ, Scadding GK, Gevaert P et
al. Reduced need for surgery in severe nasal polyposis with
mepolizumab: randomized trial. Journal of Allergy and Clinical
Immunology 2017; 140: 1024-1031.
- 26. Gevaert P, Van Bruaene N, Cattaert T, Van Steen K, Van
Zele T et al. Mepolizumab, a humanized anti-IL-5 mAb, as a
treatment option for severe nasal polyposis. Journal of Allergy
and Clinical Immunology 2011; 128: 989-995.
- 27. Heffler E, Nascimento Girardi Madeira L, Ferrando M,
Puggioni F, Racca F et al. Inhaled corticosteroids safety and
adverse effects in patients with asthma. Journal of Allergy and
Clinical Immunology: In Practice 2018; 3: 2213-2198.
- 28. Pelaia C, Busceti MT, Solinas S, Terracciano R, Pelaia G. Real-life
evaluation of the clinical, functional, and hematological effects
of mepolizumab in patients with severe eosinophilic asthma:
results of a single-centre observational study. Pulmonary
Pharmacology and Therapeutics 2018; 53: 1-5.
- 29. Yancey SW, Keene ON, Albers FC, Ortega H, Bates S et al.
Biomarkers for severe eosinophilic asthma. Journal of Allergy
and Clinical Immunology 2017; 140: 1509-1518.
- 30. Ortega HG, Yancey SW, Mayer B, Gunsoy NB, Keene ON et al.
Severe eosinophilic asthma treated with mepolizumab stratified
by baseline eosinophil thresholds: a secondary analysis of the
DREAM and MENSA studies. Lancet Respiratory Medicine
2016; 4: 549-556.
- 31. Price DB, Rigazio A, Campbell JD, Bleecker ER, Corrigan CJ et al.
Blood eosinophil count and prospective annual asthma disease
burden: a UK cohort study. Lancet Respiratory Medicine 2015;
3(11): 849-858.
- 32. Zeiger RS, Schatz M, Li Q, Chen W, Khatry DB et al. High blood
eosinophil count is a risk factor for future asthma exacerbations
in adult persistent asthma. Journal of Allergy and Clinical
Immunology: In Practice 2014; 2(6): 741-750.
- 33. Gunsoy NB, Cockle SM, Yancey SW, Keene ON, Bradford ES et
al. Evaluation of potential continuation rules for mepolizumab
treatment of severe eosinophilic asthma. Journal of Allergy and
Clinical Immunology: In Practice 2018; 6(3): 874-882.
- 34. Flood-Page PT, Menzies-Gow AN, Kay AB, Robinson DS.
Eosinophil’s role remains uncertain as anti-interleukin-5 only
partially depletes numbers in asthmatic airway. American
Journal of Respiratory and Critical Care Medicine 2003; 167:
199-204.
- 35. Gerhardsson de verdier M, Gustafson P, McCrae C, Edsbäcker
S, Johnston N. Seasonal and geographic variations in the
incidence of asthma exacerbations in the United States. Journal
Asthma 2017; 54: 818-824.