In patients with severe asthma, mepolizumab significantly reduced clinically significant exacerbations and improved asthma control across all eosinophil levels compared with benralizumab and reslizumab. Findings from this indirect treatment comparison were published in The Journal of Allergy and Clinical Immunology.

Currently, 3 anti-interleukin (IL)5 pathway-directed treatments (benralizumab, mepolizumab, reslizumab) have been approved by the Food and Drug Administration for the treatment of severe asthma with an eosinophilic phenotype. For this study, researchers used a recent Cochrane review on anti-IL5 treatments as well as additional studies involving patients ≥12 years with severe asthma treated with anti-IL5 therapy. “Only licensed doses used in clinical practice were included and patients were matched according to blood eosinophil counts and asthma control scores. This approach ensured a robust comparison, which will help inform doctors when making clinical decisions about treating their patients,” said lead author Dr William Busse, Professor of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Department at the University of Wisconsin Medical School in Madison, Wisconsin.

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Results showed that compared with placebo, all 3 treatments significantly reduced the rate of clinically significant exacerbations and improved asthma control in all blood eosinophil subgroups.

Compared with benralizumab, mepolizumab reduced clinically significant exacerbations by 34-45% across blood eosinophil subgroups (all P<.05):

  • ≥400 cells/µL: rate ratio (RR) 0.55 (95% CI, 0.35, 0.87)
  • ≥300 cells/µL: RR 0.61 (95% CI, 0.37, 0.99)
  • ≥150 cells/µL: RR 0.66 (95% CI, 0.49, 0.89)

Moreover, compared with reslizumab, mepolizumab reduced clinically significant exacerbations by 45% in the ≥400cells/µL subgroup (P<.007).

With regard to asthma control, mepolizumab was associated with significantly greater improvements in change from baseline in the Asthma Control Questionnaire score vs benralizumab and reslizumab. No significant differences were noted between the 3 agents with regard to lung function or reductions in exacerbations requiring emergency department visit/hospitalization.

“In the absence of head-to-head comparisons, this indirect treatment comparison provides clinically relevant, comparative information on the efficacy of licensed formulations of the 3 approved anti-IL5 pathway therapies in [severe eosinophilic asthma] by baseline blood eosinophil count,” write the authors.

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