Exacerbations in patients with severe asthma who are being treated with mepolizumab can be categorised into two distinct types, UK researchers have reported.
The results suggest that a more precision medicine approach may be useful in treating acute wheezing episodes in this group of patients.
Data from a study at four specialist severe asthma centres showed that patients with non-eosinophilic events are driven by infection and present with low fractional exhaled nitric oxide (FeNO) and high C-reactive protein concentration.
By contrast patients with high eosinophil counts when they had exacerbations also have high FeNO.
The researchers said that the two distinct entities shown in their analysis of 140 participants with severe eosinophilic asthma eligible for mepolizumab therapy could largely be differentiated using FeNO.
It challenges the routine use of oral corticosteroids for the treatment of all asthma exacerbation events in patients taking mepolizumab, they concluded in The Lancet Respiratory Medicinee.
And raises questions about switching of biological therapies for treatment failure without first profiling the inflammatory phenotype of ongoing asthma exacerbations.
The MEX study analysis also shows that there are clinically available tools that can be used to ‘profile’ exacerbations in patients treated with mepolizumab, the researchers added.