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The REALITI of mepolizumab: reduced corticosteroid use in severe asthma

Published: June 23, 2022

People with severe asthma have a disease that is difficult to control. When symptoms worsen, causing an asthma attack, treatment with corticosteroid tablets may be needed. Unfortunately, repeated courses of corticosteroid tablets lead to other health problems and there is an important need for medications to improve disease control while reducing the steroid burden faced by people with severe asthma.

Mepolizumab is a specialized medicine for treating severe asthma. It works by preventing the immune system from creating the inflammation that often leads to asthma attacks. In clinical trials, mepolizumab has been shown to reduce the use of corticosteroid tablets and help reduce asthma attacks in people with severe asthma. The benefits of mepolizumab have also been reported across a range of real-life studies. Real-life studies report what happens to patients when they are treated in routine clinical care. These studies are important because they better reflect the variety of patients that doctors treat compared with the more restricted populations included in clinical trials. Until recently, real-life mepolizumab studies have included either a small number of people or they were restricted to regional populations. Therefore, there has been a need to study the real-life effect of mepolizumab across a broader and more varied sample of people with severe asthma.

In a recent research article in The Journal of Allergy and Clinical Immunology: In Practice, Pilette and colleagues present data from the REALITI-A study. This was a real-life study that included adults with severe asthma who were starting mepolizumab treatment based on their doctor’s recommendation. The REALITI-A study is the largest of its kind, involving 822 patients from a total of 7 countries within Europe, Canada, and the USA. After starting mepolizumab treatment, patients were monitored for 2 years, and this article reports results after 1 year. The main aim of the article was to report the real-life effect of mepolizumab in reducing corticosteroid tablet use, either used daily as part of routine patient care, or those used to help treat asthma attacks (rescue bursts).  

Pilette and colleagues highlight that approximately 4 in 10 patients relied on daily corticosteroid tablets for their asthma treatment before starting mepolizumab. After one year, patients had reduced their daily dose by 75%, from 10 mg to 2.5 mg. Importantly, in patients taking daily corticosteroid tablets before starting mepolizumab treatment, 4 in 10 were able to completely stop taking these tablets by the end of one year. At the same time, the number of asthma attacks these patients experienced reduced by over 70%, indicating that rescue bursts of corticosteroids were also reduced. Overall, these results from the REALITI-A study reported by Pilette and colleagues support the real-life use of mepolizumab to help reduce corticosteroid dependency and the associated burden from using corticosteroids in people with severe asthma.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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