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Treatment of Steroid-Dependent Asthmatics with Mepolizumab
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A1393 - Treatment of Steroid-Dependent Asthmatics with Mepolizumab
Author Block: R. A. Strauss; Cleveland Allergy and Asthma Center, Fairview Park, OH, United States.
INTRODUCTION:
Severe asthma is associated with significant morbidity, mortality, and increased health costs. It affects about 10% of all patients with asthma, approximately 2.5 million Americans. In spite of daily treatment with high-dose inhaled corticosteroids with a long acting beta agonist (ICS/LABA) or another controller medication, daily corticosteroids are frequently required, as well as bursts of prednisone because of frequent exacerbations. Mepolizumab, a monoclonal antibody directed against interleukin 5 cytokine (which is involved with eosinophil lifecycle) has been shown in several large controlled studies to decrease symptoms in asthmatics with an eosinophilic phenotype.
RATIONALE:
While double-blind controlled studies have shown the efficacy of mepolizumab in severe eosinophilic asthma, I would like to report the real-world results of using this drug in clinical practice. This was a retrospective study to determine the efficacy of mepolizumab on 13 steroid-dependent asthmatics ranging in age from 35 to 91, with a mean of 57.
METHODS:
Patients were required to have an eosinophil count greater than 150 cells/mcL, treated with daily prednisone ranging from 7 mg to 25 mg per day, with daily ICS/LABA, two inhalations b.i.d., and frequent use of inhaled albuterol. Previous attempts to lower the corticosteroid dose resulted in increased exacerbations. Prior to receiving their monthly subcutaneous injection of mepolizumab, the history was reviewed, Pulmonary function tests were performed, Asthma Control Questionnaire (ACQ) scores were evaluated, and auscultation of the chest was performed.
RESULTS:
7 out of 13 patients were able to discontinue prednisone completely after an average of six months, with a range of 1 to 12 months. 6 patients still required prednisone from 10 mg per day to 5 mg q.o.d. Before beginning mepolizumab their ACQ scores ranged from 0.57 to 4.0 with an average of 2.33. After 6 to 13 months, their ACQ scores ranged from 0.28 to 2.14 with an average of 1.31, a 55% improvement. There was no significant change in pulmonary function tests. One patient developed urticaria on two occasions. Overall the patients had increased energy, increased stamina, and a significant decrease in cough, wheeze, and mucus production.
CONCLUSION:
Asthmatics that require daily prednisone in spite of daily treatment with ICS/LABA with an eosinophil count greater than 150 cells/mcL should receive a trial of monthly injections of mepolizumab. A decrease in symptoms and oral corticosteroid requirements should be expected based on the significant improvement in ACQ scores in most patients.
Author Block: R. A. Strauss; Cleveland Allergy and Asthma Center, Fairview Park, OH, United States.
INTRODUCTION:
Severe asthma is associated with significant morbidity, mortality, and increased health costs. It affects about 10% of all patients with asthma, approximately 2.5 million Americans. In spite of daily treatment with high-dose inhaled corticosteroids with a long acting beta agonist (ICS/LABA) or another controller medication, daily corticosteroids are frequently required, as well as bursts of prednisone because of frequent exacerbations. Mepolizumab, a monoclonal antibody directed against interleukin 5 cytokine (which is involved with eosinophil lifecycle) has been shown in several large controlled studies to decrease symptoms in asthmatics with an eosinophilic phenotype.
RATIONALE:
While double-blind controlled studies have shown the efficacy of mepolizumab in severe eosinophilic asthma, I would like to report the real-world results of using this drug in clinical practice. This was a retrospective study to determine the efficacy of mepolizumab on 13 steroid-dependent asthmatics ranging in age from 35 to 91, with a mean of 57.
METHODS:
Patients were required to have an eosinophil count greater than 150 cells/mcL, treated with daily prednisone ranging from 7 mg to 25 mg per day, with daily ICS/LABA, two inhalations b.i.d., and frequent use of inhaled albuterol. Previous attempts to lower the corticosteroid dose resulted in increased exacerbations. Prior to receiving their monthly subcutaneous injection of mepolizumab, the history was reviewed, Pulmonary function tests were performed, Asthma Control Questionnaire (ACQ) scores were evaluated, and auscultation of the chest was performed.
RESULTS:
7 out of 13 patients were able to discontinue prednisone completely after an average of six months, with a range of 1 to 12 months. 6 patients still required prednisone from 10 mg per day to 5 mg q.o.d. Before beginning mepolizumab their ACQ scores ranged from 0.57 to 4.0 with an average of 2.33. After 6 to 13 months, their ACQ scores ranged from 0.28 to 2.14 with an average of 1.31, a 55% improvement. There was no significant change in pulmonary function tests. One patient developed urticaria on two occasions. Overall the patients had increased energy, increased stamina, and a significant decrease in cough, wheeze, and mucus production.
CONCLUSION:
Asthmatics that require daily prednisone in spite of daily treatment with ICS/LABA with an eosinophil count greater than 150 cells/mcL should receive a trial of monthly injections of mepolizumab. A decrease in symptoms and oral corticosteroid requirements should be expected based on the significant improvement in ACQ scores in most patients.
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