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Professor Peter Gibson
Mepolizumab use has led to a significant and sustained reduction in oral corticosteroids (OCS) use in patients with severe eosinophilic asthma, Australian research indicates.
Observational data from 309 patients in the Australian Mepolizumab Registry shows that in the 48% of patients using maintenance OCS before starting the biologic, there was a gradual reduction in steroid use until about half were using OCS at 12 months.
Before mepolizumab initiation, 95.5% of patients used at least one short course burst of OCS in the previous year but that reduced to 50.2% at 12 months.
Overall OCS exposure (either maintenance or burst) dropped from 97.4% at baseline to 66.7%.
“Following mepolizumab commencement, the daily dose reduced from a median (IQR) of 10 (5.0, 12.5) mg/day at baseline to 2 (0, 7.0) mg/day at 12-month follow-up (p<0.001),” the study authors said.
The effect of biologic initiation on OCS use was observed as early as the first follow-up visit at three months.
The study, published in the Journal of Allergy and Clinical Immunology in Practice, also found that asthma symptoms were well controlled in patients who were OCS free after six months of mepolizumab therapy.
But it noted there was a conundrum in that patients first had to have high OCS use in order to be eligible for mepolizumab.
“Relaxing the criteria for access to mepolizumab in Australia with a lower total dose of OCS might help these patients,” the study authors wrote.
Reset oral steroid thresholds?
Senior investigator Professor Peter Gibson, from the Priority Research Centre for Healthy Lungs in Newcastle, said the real world registry data supported other evidence from RCTs that biologic use can achieve important steroid reductions.