MEPOLIZUMAB treatment at 100 mg induces clinical remission in individuals with severe eosinophilic asthma (SEA), with the 6-month Asthma Control Questionnaire (ACQ-5) score being the best predictor of remission at 12 months.
SEA is a challenging condition that often requires biologic treatment options. Mepolizumab, a monoclonal antibody targeting IL-5, has shown potential in inducing clinical remission in patients with SEA. This study aimed to determine whether early response to mepolizumab could predict long-term clinical outcomes and identify the most reliable predictor for achieving remission.
The research utilised the Australian Mepolizumab Registry to evaluate the early response to mepolizumab at 3 and 6 months, with the goal of correlating these responses with clinical remission at 12 months. Key outcomes, including the 5-item ACQ-5, oral corticosteroid (OCS) dose, exacerbation frequency, and postbronchodilator FEV1, were assessed. Clinical remission was defined by an ACQ-5 score of ≤1.0, no exacerbations, and no OCS use over the preceding 6 months. Among the 255 participants analysed, 78 (30.6%) achieved clinical remission at 12 months. The results showed that the 6-month ACQ-5 score was a stronger predictor of remission than the 3-month score. Specifically, an ACQ-5 score of less than 1.5 at 6 months demonstrated a sensitivity of 85.9% for remission, while a score of less than 0.75 had a specificity of 84.7%. The 6-month ACQ-5 score had the highest optimism-corrected area under the curve of 0.778 (95% CI: 0.719–0.833).
The findings highlight that the ACQ-5 score at 6 months is a reliable predictor of long-term clinical remission in patients with SEA treated with mepolizumab. This information could be pivotal in developing a treat-to-target approach in clinical practice, where patient responses at 6 months are assessed to determine the likelihood of achieving remission at 12 months. These results should guide clinicians in optimising treatment plans for SEA, with the potential for earlier interventions or adjustments based on patient response.
Reference
Hamada Y et al. Early treatment response to mepolizumab predicts clinical remission in severe eosinophilic asthma. J Allergy Clin Immunol Pract. 2024;S22132198(24)01160-7.
