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Mepolizumab: sustained safety and efficacy in severe eosinophilic asthma

Published online: October 22, 2018

Patients with severe asthma vary widely in their symptoms and physiology and can respond quite differently to different asthma treatments. Mepolizumab is a biologic treatment for severe eosinophilic asthma in which white blood cells called eosinophils are mediators of inflammation and disease. Mepolizumab targets interleukin-5 (IL-5), a key immune signaling molecule for eosinophil function. The blocking of IL-5 by mepolizumab in turn reduces the numbers of eosinophils in the blood. In clinical trials conducted for up to 1 year, mepolizumab showed a favorable safety profile, and meaningful benefits in reducing the occurrence of asthma attacks and improving patients’ quality of life, when added to existing standard asthma treatments. However, long-term data for mepolizumab beyond 1 year are needed.

In a recently published article in The Journal of Allergy & Clinical Immunology (JACI), Khatri and colleagues analyzed the safety and efficacy of mepolizumab in patients with severe eosinophilic asthma who were receiving treatment for up to 4.5 years. They collected data from nearly 350 patients enrolled in the multicenter COLUMBA study, which investigated a number of different safety and clinical outcomes, including adverse events and number of asthma attacks occurring during treatment. They also assessed whether patients developed an immune response to mepolizumab.

The authors found no new safety concerns with long-term mepolizumab treatment. A sustained decrease in asthma attacks occurred during the study, with one-third of patients not experiencing any attacks, and among patients who participated in the study for at least 3 years, there was a 56% reduction in asthma attacks versus standard treatment. Within 4 weeks of study start, the number of blood eosinophils had decreased by over 75% and remained at this level thereafter. In keeping with previous studies, 8% of patients were found to have anti-mepolizumab antibodies, but these were at a low concentration, and no neutralizing antibodies were detected. The authors’ findings demonstrate the long-term safety and sustained clinical benefit of mepolizumab treatment for up to 4.5 years, and support its use as a long-term treatment option for patients with severe eosinophilic asthma.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

Graphical Abstract

Assessment of the long-term safety of mepolizumab and durability of clinical response in patients with severe eosinophilic asthma