Baseline blood eosinophil count as a predictor of treatment response to the licensed dose of mepolizumab in severe eosinophilic asthma

Previous analyses examining the relationship between blood eosinophil count and mepolizumab treatment effects in severe eosinophilic asthma have used a range of doses and administration routes. This post hoc meta-analysis included data from the MENSA (MEA115588/NCT01691521) and MUSCA (200862/NCT0228...

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Published in:Respiratory medicine 2019-11, Vol.159 (C), p.105806-105806, Article 105806
Main Authors: Albers, Frank C., Licskai, Christopher, Chanez, Pascal, Bratton, Daniel J., Bradford, Eric S., Yancey, Steven W., Kwon, Namhee, Quirce, Santiago
Format: Article
Language:English
Subjects:
Asthma
Blood
Blood eosinophil
Clinical trials
Cytokines
Data analysis
Emergency medical care
Emergency medical services
Exacerbation
Human health and pathology
Leukocytes (eosinophilic)
Licenses
Life Sciences
Lung function
Mepolizumab
Meta-analysis
Monoclonal antibodies
Patients
Predictor
Questionnaires
Subgroups
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description Previous analyses examining the relationship between blood eosinophil count and mepolizumab treatment effects in severe eosinophilic asthma have used a range of doses and administration routes. This post hoc meta-analysis included data from the MENSA (MEA115588/NCT01691521) and MUSCA (200862/NCT02281318) trials. Patients (≥12 years) with severe eosinophilic asthma who experienced ≥2 exacerbations in the prior year received either mepolizumab 100 mg subcutaneously (SC) or 75 mg intravenously, or placebo plus standard of care every 4 weeks. This meta-analysis reports data from patients receiving the licensed dose of mepolizumab (100 mg SC) or placebo only. The primary endpoint was the annual rate of clinically significant exacerbations; secondary endpoints included rate of exacerbations requiring hospitalization/emergency room (ER) visit, proportion of patients with no clinically significant exacerbations, and changes from baseline in forced expiratory volume in 1 s, Asthma Control Questionnaire-5 and St George's Respiratory Questionnaire scores. Analyses were stratified by baseline blood eosinophil count (
doi_str_mv 10.1016/j.rmed.2019.105806
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This post hoc meta-analysis included data from the MENSA (MEA115588/NCT01691521) and MUSCA (200862/NCT02281318) trials. Patients (≥12 years) with severe eosinophilic asthma who experienced ≥2 exacerbations in the prior year received either mepolizumab 100 mg subcutaneously (SC) or 75 mg intravenously, or placebo plus standard of care every 4 weeks. This meta-analysis reports data from patients receiving the licensed dose of mepolizumab (100 mg SC) or placebo only. The primary endpoint was the annual rate of clinically significant exacerbations; secondary endpoints included rate of exacerbations requiring hospitalization/emergency room (ER) visit, proportion of patients with no clinically significant exacerbations, and changes from baseline in forced expiratory volume in 1 s, Asthma Control Questionnaire-5 and St George's Respiratory Questionnaire scores. Analyses were stratified by baseline blood eosinophil count (&lt;150, ≥150, ≥300, ≥400, ≥500, ≥750, ≥1000, ≥150–&lt;300, or ≥300–&lt;500 cells/μL). Mepolizumab reduced annual clinically significant exacerbation rates by 45%–85%, exacerbations requiring hospitalization/ER visit by 60%–70%, and increased the odds of no clinically significant exacerbations across all eosinophil threshold subgroups versus placebo, and improved all other secondary endpoints in subgroups ≥150 cells/μL. Greater treatment effects with increasing blood eosinophil count were observed. Mepolizumab demonstrated consistent clinical benefits in patients with baseline blood eosinophil counts ≥150 cells/μL, confirming the suitability of this cut-off for identifying patients responsive to the licensed mepolizumab dose. •Mepolizumab is effective at blood eosinophil counts ≥150 cells/μL in severe asthma.•Higher baseline blood eosinophil counts lead to greater mepolizumab response vs PBO.•A blood eosinophil count threshold ≥150 cells/μL selects mepolizumab responders.</description><identifier>ISSN: 0954-6111</identifier><identifier>EISSN: 1532-3064</identifier><identifier>DOI: 10.1016/j.rmed.2019.105806</identifier><identifier>PMID: 31751853</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Asthma ; Blood ; Blood eosinophil ; Clinical trials ; Cytokines ; Data analysis ; Emergency medical care ; Emergency medical services ; Exacerbation ; Human health and pathology ; Leukocytes (eosinophilic) ; Licenses ; Life Sciences ; Lung function ; Mepolizumab ; Meta-analysis ; Monoclonal antibodies ; Patients ; Predictor ; Questionnaires ; Subgroups</subject><ispartof>Respiratory medicine, 2019-11, Vol.159 (C), p.105806-105806, Article 105806</ispartof><rights>2019 Elsevier Ltd</rights><rights>Copyright © 2019 Elsevier Ltd. 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subjects Asthma
Blood
Blood eosinophil
Clinical trials
Cytokines
Data analysis
Emergency medical care
Emergency medical services
Exacerbation
Human health and pathology
Leukocytes (eosinophilic)
Licenses
Life Sciences
Lung function
Mepolizumab
Meta-analysis
Monoclonal antibodies
Patients
Predictor
Questionnaires
Subgroups
title Baseline blood eosinophil count as a predictor of treatment response to the licensed dose of mepolizumab in severe eosinophilic asthma
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