- Title
- Mepolizumab and Oral Corticosteroid Stewardship: Data from the Australian Mepolizumab Registry
- Creator
- Thomas, Dennis; Harvey, Erin S.; Bardin, Philip; Peters, Matthew; Reynolds, Paul N.; Langton, David; Baraket, Melissa; Bowden, Jeffrey J.; Bowler, Simon; Chien, Jimmy; Chung, Li Ping; Farah, Claude S.; McDonald, Vanessa M.; Wark, Peter A. B.; Gibson, Peter G.; Katsoulotos, GP; Lee, J; Radhakrishna, N; Reddel, HK; Rimmer, J; Sivakumaran, P; Wark, PAB; Gibson, PG; Stevens, Sean; Upham, John W.; Katelaris, Constance H.; Kritikos, Vicky; Gillman, Andrew; Harrington, John; Hew, Mark
- Relation
- Journal of Allergy and Clinical Immunology: In Practice Vol. 9, Issue 7, p. 2715-2724.e5
- Publisher Link
- http://dx.doi.org/10.1016/j.jaip.2021.01.028
- Publisher
- Elsevier
- Resource Type
- journal article
- Date
- 2021
- Description
- 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.
- Subject
- oral corticosteroid; mepolizumab; severe eosinophilic asthma; OCS stewardship; observational study; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1464714
- Identifier
- uon:47085
- Identifier
- ISSN:2213-2198
- Language
- eng
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