REALITI-A Study: Real-World Oral Corticosteroid-Sparing Effect of Mepolizumab in Severe Asthma

被引:38
|
作者
Pilette, Charles [1 ,2 ]
Canonica, Giorgio Walter [3 ,4 ]
Chaudhuri, Rekha [5 ,6 ]
Chupp, Geoffrey [7 ]
Lee, F. Eun-Hyung [8 ]
Lee, Jason Kihyuk [9 ]
Almonacid, Carlos [10 ]
Welte, Tobias [11 ,12 ]
Alfonso-Cristancho, Rafael [13 ]
Jakes, Rupert W. [14 ]
Maxwell, Aoife [15 ]
Price, Robert G. [16 ]
Howarth, Peter [17 ]
机构
[1] Clin Univ St Luc, Dept Pulm Med, Brussels, Belgium
[2] UCLouvain, Inst Expt & Clin Res, Pneumol ENT & Dermatol, Brussels, Belgium
[3] Humanitas Univ, Dept Biomed Sci, Milan, Italy
[4] IRCCS Humanitas Res Hosp, Personalized Med Asthma & Allergy Clin, Milan, Italy
[5] Gartnavel Royal Hosp, Asthma COPD Clin Res Ctr, Glasgow, Lanark, Scotland
[6] Univ Glasgow, Inst Infect Immun & Inflammat, Glasgow, Lanark, Scotland
[7] Yale Sch Med, Div Pulm Crit Care & Sleep Med, Dept Internal Med, New Haven, CT USA
[8] Emory Univ, Dept Med, Div Pulm Allergy Crit Care & Sleep Med, Atlanta, GA 30322 USA
[9] Toronto Allergy & Asthma Clin, Toronto, ON, Canada
[10] H Ramon y Cajal, Dept Neumol, Madrid, Spain
[11] Hannover Med Sch, Dept Resp Med, Hannover, Germany
[12] Hannover Med Sch, German Ctr Lung Res, Hannover, Germany
[13] GSK, Value Evidence & Outcomes, Collegeville, PA USA
[14] GSK, Epidemiol, London, England
[15] GSK, Real World Study Delivery Value Evidence & Outcom, Stevenage, Herts, England
[16] GSK, Biostat, Stevenage, Herts, England
[17] GSK, Global Med Franchise, Brentford, Middx, England
关键词
Oral corticosteroids; Mepolizumab; Real-world; Prospective; Eosinophils; Severe asthma; Asthma exacerbations; DOUBLE-BLIND; EOSINOPHILS; MULTICENTER; THERAPY; LIFE;
D O I
10.1016/j.jaip.2022.05.042
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
BACKGROUND: Patients with severe asthma may require maintenance oral corticosteroids (mOCS) for disease control as well as systemic corticosteroid (SCS) bursts for clinically significant exacerbations. However, mOCS and SCS use are associated with adverse effects, which increases patient disease burden. OBJECTIVE: To assess the real-world corticosteroid-sparing effect of mepolizumab in patients with severe asthma. METHODS: REALITI-A was a 24-month international, prospective, observational cohort study involving 84 centers across Europe, Canada, and the United States, with a 1-year pre-post mepolizumab treatment preplanned interim analysis. A total of 822 adults with a clinical diagnosis of asthma and a physician decision to initiate mepolizumab treatment (100 mg subcutaneously) were included. End points included daily mOCS dose at baseline (penultimate 28 days of pretreatment) and 1 year after treatment; percent reduction from baseline in mOCS dose; patients discontinuing mOCS 1 year after treatment; and the rate of clinically significant exacerbations (those requiring OCS for 3 days or more [or parenteral administration], emergency room visit, and/or hospital admission) before and after treatment. RESULTS: A total of 319 patients received mOCS at baseline (median [interquartile range]: 10.0 [5.0-15.0] mg/d). At 1 year after treatment, median mOCS dose was reduced by 75% (2.5 [0.0-5.0] mg/d); 64% of patients had a reduction in mOCS dose of 50% or greater compared with baseline and 43% discontinued mOCS. Clinically significant exacerbations decreased between pretreatment and posttreatment (rate ratio [95% confidence interval] 0.29 [0.26-0.32]; P < .001). CONCLUSION: This 1-year analysis demonstrates that real-world mepolizumab treatment is clinically effective in patients with severe asthma, providing disease control while reducing the need for mOCS and SCS bursts. (C) 2022 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.
引用
收藏
页码:2646 / 2656
页数:11
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