Introduction:Monoclonal antibodies are the pillar of individualized treatment of severe asthma. However, there is often phenotypic overlap in patients with severe asthma, and these patients may be eligible for more than one of the available therapies and switching between treatments as to achieve the best clinical response.
Objective:The clinical benefit of patients with severe asthma who, due to non-response, switched from omalizumab to mepolizumab.
Materials-methods:This is the post-hoc analysis of the 2-year prospective, multicenter, non-interventional observational study,RELIght. 2 groups of patients were studied:(A)those who received and (B)those who did not receive omalizumab in the past, before starting treatment with mepolizumab.
Results:Of the 169 patients, 60 (35.5%,19 men,median age 59[49.5,67.5]years) had received previous treatment with omalizumab. In Group(A) switching to mepolizumab reduced mean annual exacerbations(CSE) by 67% at the 1st and 69% at 2 years. A corresponding reduction was observed in group(B).Symptom control (ACT,p<0.001) and pulmonary function (FEV1,p<0.001) were also improved clinically significant in both groups at both years of follow-up (Table).
Conclusions:The choice of mepolizumab allows patients with severe eosinophilic asthma to achieve clinical improvement regardless of the history of previous treatment with omalizumab.
| Median[Q25,75] | Group A | Group B |
| CSE | ||
| Baseline | 4[3,6] | 4[3,5] |
| 1 year |
1[0,2] |
1[0,1] |
| 2 years |
2[1,4] |
1[0,3] |
| ACT | ||
| Baseline | 16[12,18] | 16[12,18] |
| 1 year | 22[20,24] | 23[21,24] |
| 2 years | 21[20,24] | 23[21,24] |
| FEV1(L) | ||
| Baseline | 1.7[1.3,2.3] | 1.8[1.4,2.4] |
| 1 year | 2[2.6,1.6] | 2.2[1.7,2.7] |
| 2 years | 2.1[1.5,2.4] | 2.3[1.7,2.7] |