Reslizumab treatment significantly benefits exacerbation-prone patients with severe eosinophilic asthma
Published online: June 17, 2020
Up to 10% of patients with asthma have severe disease. As disease severity increases, so too does the risk of potentially life-threatening exacerbations. Patients with an eosinophilic type of severe asthma, characterized by elevated eosinophil counts, have an even greater risk of exacerbations, in addition to further impaired lung function and a lower quality of life compared with patients with non-eosinophilic asthma.
Reslizumab, a monoclonal antibody that disrupts the lifecycle of eosinophils by targeting interleukin-5 (IL-5), has been shown to reduce exacerbations and improve lung function in patients with asthma. However, Phase 3 trials of reslizumab assessed efficacy in patients with moderate to severe asthma and ≥ 1 exacerbation in the 12 months prior to the study, whereas Phase 3 trials for alternative drugs that target the IL-5 pathway assessed the treatment effect in patient populations with severe asthma and ≥ 2 exacerbations in the prior 12 months.
In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, results from two Phase 3 trials, which reported the efficacy and safety of intravenous reslizumab in patients with eosinophilic asthma, were analyzed on a post hoc basis. Wechsler and colleagues investigated the treatment effect in a subgroup of the patient population considered severe and exacerbation-prone, specifically those who had experienced ≥ 2 exacerbations in the 12 months prior to screening and required GINA 4/5 treatment at baseline. Outcomes assessed included the rate of exacerbations, lung function, asthma control, quality of life, and systemic corticosteroid burden after 52 weeks of weight-based treatment with either reslizumab or placebo.
The authors found that, after one year of treatment, reslizumab significantly improved the rate of exacerbations, time to first exacerbation, and the proportion of patients who experienced ≥ 1 exacerbation versus placebo. Furthermore, improvements in lung function, asthma control, quality of life, and systemic corticosteroid burden were also observed with reslizumab versus placebo in both subgroups of patients with severe asthma who experienced ≥ 2 and those with ≥ 3 exacerbations. This study suggests that exacerbation-prone patients with severe eosinophilic asthma are highly responsive to treatment with reslizumab for asthma-related outcomes. Therefore, these findings indicate that this patient population may obtain significant benefit from reslizumab add-on therapy.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.