Impact of atopic status, prior omalizumab use and baseline blood eosinophil count alone and in combination with total serum IgE on maintenance OCS reduction outcomes in patients with severe asthma treated with mepolizumab in the REALITI-A study
M. Liu , R. Chaudhuri , G. Chupp , L.G. Heaney , J.K. Lee , C. Pilette , G. Brusselle , R. Alfonso-Cristancho , L. Zhang , P. Howarth , A. Kumar
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引用次数: 0
Abstract
Prérequis/contexte
Maintenance OCS (mOCS) are commonly used for patients with severe asthma, despite well-recognized adverse event risk. Biologics have facilitated reduced mOCS reliance, e.g., the IL-5 inhibitor mepolizumab reduced mOCS dependence in patients with asthma in clinical trials and real-world studies.
Objectifs
This post hoc analysis of REALITI-A explored 2-year mOCS outcomes for patients receiving mOCS at baseline stratified by prior treatment with/eligibility for omalizumab, baseline blood eosinophil count (BEC) and serum total IgE and atopic status. Outcomes included 2-year change from baseline mOCS daily dose.
Méthodes
REALITI-A was a 2-year international, prospective, single-arm, real-world study enrolling patients with asthma newly prescribed mepolizumab (index date).
Résultats/discussions
Of 822 REALITI-A patients, 320 (38.9%) were receiving mOCS at baseline and 168 also had mOCS daily dose data after 2 years. Of patients who could be assessed for omalizumab eligibility (n = 114; 54 could not be assessed), 56% who were eligible at baseline had 100% reduction in mOCS daily dose after 2 years, versus 58% who were ineligible. Omalizumab use was associated with a numerical trend towards smaller proportion of patients with 100% mOCS daily dose reduction (48% with vs 59% without). More patients with BEC ≥300 cells/μL (67%) achieved 100% mOCS withdrawal than BEC <300 cells/μL (47%). For BEC/IgE, the proportion of patients with 100% reduction in mOCS use was highest for ≥300 cells/μL/≥81 KU/L (73 vs 55% for <300 cells/μL/ < 81 KU/L, 47% for <300 cells/μL/≥81 KU/L and 56% for ≥300 cells/μL/ < 0.81 KU/L). Among the patients with atopic status, 62% had 100% reduction in mOCS daily dose versus 67% without. Median mOCS dose reduction was ≥70% regardless of omalizumab use/eligibility, baseline BEC (/IgE), or atopic status.
Conclusion
These results reinforce mepolizumab effectiveness in severe asthma, demonstrating that real-world treatment is associated with mOCS independence regardless of prior biologic use and biomarkers.
期刊介绍:
La Revue Française d''Allergologie : un véritable forum pour faire connaître des travaux originaux et permettre la diffusion de l''information auprès de toutes les spécialités concernées par les pathologies allergiques. La Revue Française d''Allergologie (8 numéros par an) est au carrefour de nombreuses spécialités - dermatologie, pédiatrie, ORL, pneumologie, ophtalmologie, médecine interne - qui, toutes, ont à traiter des maladies allergiques. Les symptômes des allergies fondés sur des mécanismes communs sont le plus souvent associés et se succèdent chez un même patient. En forte progression depuis 20 ans, les maladies allergiques sont dans l''attente de perfectionnements et d''avancées thérapeutiques qui permettront aux nombreux patients qui en sont atteints de mieux vivre avec leurs allergies. La Revue Française d''Allergologie se veut donc un véritable forum de discussions et d''échanges entre tous les spécialistes confrontés aux pathologies