Mepolizumab is a humanized monoclonal antibody used to treat severe eosinophilic asthma. We caught up with Dr Ronald Strauss (Case Western Reserve University; Cleveland Allergy and Asthma Center, Cleveland, OH, USA), a valued member of our Editorial Board for touchREVIEWS in Respiratory & Pulmonary Diseases, to discuss the rationale, findings and clinical significance of his recent retrospective study, which looked at the efficacy of mepolizumab in patients with severe eosinophilic asthma over a period of 6 years.
The abstract ‘Asthmatic super responders treated with mepolizumab up to six years‘ (Abstract number: 065) was presented at AAAAI 2023, February 24–27, 2022, #AAAAI2023.
Questions
- What is mepolizumab and what is its mechanism of action? (0:22)
- What is already known about the clinical utility of mepolizumab in the treatment of severe eosinophilic asthma? (0:58)
- What was the rationale for your study? (2:14)
- Can you tell us a little about the design and findings of your study? (3:47)
- What is the potential clinical significance of these findings? (6:42)
Disclosures: Ronald Strauss has nothing to disclose in relation to this video.
Support: Interview and filming supported by Touch Medical Media Ltd. Interview conducted by Atiya Henry.
Filmed in coverage of the American Academy of Allergy Asthma & Immunology Annual Meeting 2023.
Transcript:
Hi, this is Dr Ronald Strauss. I’m a Clinical Assistant Professor at Case Western Reserve and in private practice running the Cleveland Allergy and Asthma Center, which specializes in taking care of severe asthmatics.
What is mepolizumab and what is its mechanism of action? (0:22)
Mepolizumab is a monoclonal antibody that binds to interleukin 5 and it binds to the IL-5 RA unit of the eosinophil, and the IL-5 is extremely important for the development and maturation of eosinophils, and that is the type of white blood cell that is so important in the seriousness of asthma.
What is already known about the clinical utility of mepolizumab in the treatment of severe eosinophilic asthma? (0:58)
Mepolizumab is given once a month subcutaneously. We’ve been doing this for almost 6 and 1/2 years, and we hope to report the wonderful results that we’ve had. There really are no side effects of significance, only occasional irritation at the site of infection, and it is basically very well tolerated. This drug has really turned around our practice because since we specialize in taking care of severe asthmatics, we had over 21 patients that were on daily prednisone and attempts to decrease the prednisone were resulting in exacerbation of the asthma. This drug has absolutely revolutionized our practice and has decreased the need for prednisone, which everyone is aware of the wide variety of side effects. It’s been the most exciting six years of my practice.
What was the rationale for your study? (2:14)
This was actually a retrospective study. At some point, since no one had reported more than 4 and 1/2 years of the use of mepolizumab, we decided to look at our patients’ history from six months to 6 and 1/2 years, and showed its efficacy. I’m usually not terribly comfortable starting a new drug and waiting a few years. However, there were some very exciting studies starting from 2012, and that was the DREAM, MENSA and MUSCA studies in 2017 that showed the safety and efficacy of mepolizumab. In 2015, we started using mepolizumab on patients that had to be on an inhaled corticosteroid, a long acting beta agonist, frequent use of an albuterol inhaler, and also either they were on daily prednisone or required frequent bursts of prednisone. Those were the criteria to start, and as I said, it’s been very efficacious and very safe. The enthusiasm of the patients is very heartwarming and it’s very exciting, not just for myself, but for my staff.
Can you tell us a little about the design and findings of your study? (3:47)
The design was a retrospective study and we looked at the ACQ6, which is an asthma control questionnaire, and the ACQ7, which is the asthma control questionnaire plus the FEV1, which is a spirometric value. The first six parts are the subjective evaluations of the patient – how often they use their inhalers, how often they cough, how often they were up at night. It’s been very interesting, and that’s what we’ll be reporting once our paper is accepted. But if you review the literature, the FEV1 really evaluates what is termed as ‘large airways’ and at the eighth branching of the bronchial tubes to the 23rd, those are called ‘small airway disease’, otherwise known as SAD. SAD plays an incredibly important role in the severity of asthma. What was surprising to us is as we review the literature of dozens of papers, we only found two from Italy that actually talked about the FEV 25-75 even though there’s some articles that alluded to it. In our study, we found 30% increase the FEV 25-75 and the FEV1 was almost the same as 6 years ago. There’s a very important study by a professor at the Cleveland Clinic, Dr Khatri, that looked at over 300 patients with severe eosinophilic asthma, and the FEV1 was exactly the same, similar to our findings. The comment of the group was there seemed to be a discrepancy between the efficacy of the drug and the pulmonary functions. We talk about now, when we looked at what’s called the ‘super responders’, the median increase in the FEV 25-75 is 40%. So, we suggest that in that study as well as others, where there was not much of a change in the FEV1, if they looked at the FEV 25-75, this might very well show a significant increase and therefore correlate with the excellent findings from mepolizumab.
What is the potential clinical significance of these findings? (6:42)
The significance is that it decreases the need for prednisone and the severity of the asthma. While we have very good medications and a large percentage do very well, there’s 5% to 10% that are severe asthma attacks that require prednisone. The significance is that we’re able to decrease the need for prednisone, which is most exciting, to say the least.
Subtitles and transcript are autogenerated
