Mepolizumab and Oral Corticosteroid Stewardship: Data from the Australian Mepolizumab Registry.

Adrenal Cortex Hormones / therapeutic use Aged Anti-Asthmatic Agents / therapeutic use Antibodies, Monoclonal, Humanized Australia / epidemiology Female Humans Male Middle Aged Registries
Mepolizumab OCS stewardship Observational study Oral corticosteroid Severe eosinophilic asthma

Journal

The journal of allergy and clinical immunology. In practice
ISSN: 2213-2201
Titre abrégé: J Allergy Clin Immunol Pract
Pays: United States
ID NLM: 101597220

Informations de publication

Date de publication:
07 2021
Historique:
received: 08 10 2020
revised: 13 01 2021
accepted: 14 01 2021
pubmed: 6 2 2021
medline: 23 7 2021
entrez: 5 2 2021
Statut: ppublish

Résumé

Oral corticosteroids (OCS) carry serious health risks. Innovative treatment options are required to reduce excessive exposure and promote OCS stewardship. 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. This real-world observational study included 309 patients from the Australian Mepolizumab Registry who were followed up for 1 year (n = 225). 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). 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.

Sections du résumé

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.

Identifiants

DOI: 10.1016/j.jaip.2021.01.028 PMID: 33545399
pubmed: 33545399
pii: S2213-2198(21)00156-2
doi: 10.1016/j.jaip.2021.01.028
pii:
doi:

Substances chimiques

Adrenal Cortex Hormones 0
Anti-Asthmatic Agents 0
Antibodies, Monoclonal, Humanized 0
mepolizumab 90Z2UF0E52

Types de publication

Journal Article Observational Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

2715-2724.e5

Informations de copyright

Copyright © 2021 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Auteurs

Dennis Thomas (D)

Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Newcastle, Australia.

Erin S Harvey (ES)

Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Newcastle, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia.

Vanessa M McDonald (VM)

Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Newcastle, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia.

Sean Stevens (S)

Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Newcastle, Australia.

John W Upham (JW)

Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, the University of Queensland, Brisbane, Australia.

Constance H Katelaris (CH)

School of Medicine, Western Sydney University, Campbelltown, Australia; Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, Australia.

Vicky Kritikos (V)

Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia.

Andrew Gillman (A)

Allergy, Asthma and Clinical Immunology Clinic, Alfred Health, Melbourne, Australia.

John Harrington (J)

Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia.

Mark Hew (M)

Allergy, Asthma and Clinical Immunology Clinic, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

Philip Bardin (P)

Lung Sleep Allergy & Immunology, Monash University and Medical Centre and Hudson Institute, Clayton, Melbourne, Australia.

Matthew Peters (M)

Department of Thoracic Medicine, Concord Hospital, Concord, Australia.

Paul N Reynolds (PN)

Lung Research Unit, Department of Thoracic Medicine, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.

David Langton (D)

Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia; Department of Thoracic Medicine, Frankston Hospital, Frankston, Australia.

Melissa Baraket (M)

South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Department of Respiratory Medicine, Ingham Institute for Applied Medical Research, Sydney, Australia.

Jeffrey J Bowden (JJ)

Respiratory and Sleep Services, Flinders Medical Centre and Flinders University, Bedford Park, Australia.

Simon Bowler (S)

Department of Respiratory Medicine, Mater Hospital, Brisbane, Australia.

Jimmy Chien (J)

Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Australia; School of Medicine, the University of Sydney, Sydney, Australia.

Li Ping Chung (LP)

Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Australia.

Claude S Farah (CS)

Department of Thoracic Medicine, Concord Hospital, Concord, Australia; Concord Clinical School, University of Sydney, Concord, Australia.

Christopher Grainge (C)

Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia.

Christine Jenkins (C)

Department of Thoracic Medicine, Concord Hospital, Concord, Australia; Concord Clinical School, University of Sydney, Concord, Australia.

Gregory P Katsoulotos (GP)

St George Specialist Centre, Kogarah, Australia; St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia; Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia.

Joy Lee (J)

Department of Respiratory Medicine Austin Health, Melbourne, Victoria, Australia.

Naghmeh Radhakrishna (N)

Respiratory Department, St Vincent's Hospital, Melbourne, Australia.

Helen K Reddel (HK)

Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia; Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia.

Janet Rimmer (J)

Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia; Department of Thoracic Medicine, St Vincent's Clinic, Darlinghurst, Australia.

Pathmanathan Sivakumaran (P)

Department of Respiratory Medicine, Gold Coast University Hospital, Gold Coast, Australia.

Peter A B Wark (PAB)

Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Newcastle, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia.

Peter G Gibson (PG)

Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Newcastle, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia. Electronic address: peter.gibson@newcastle.edu.au.

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Classifications MeSH

questionsmedicales.fr › Hormones corticosurrénaliennes › Mepolizumab and Oral Corticosteroid...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Mepolizumab and Oral Corticosteroid...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents de l'appareil respiratoire › Antiasthmatiques › Mepolizumab and Oral Corticosteroid...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Globulines › Sérum-globulines › Immunoglobulines › Anticorps › Anticorps monoclonaux › Anticorps monoclonaux humanisés › Mepolizumab and Oral Corticosteroid...
questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › Mepolizumab and Oral Corticosteroid...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Mepolizumab and Oral Corticosteroid...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Mepolizumab and Oral Corticosteroid...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enregistrements › Mepolizumab and Oral Corticosteroid...