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A Real World, Single Center Experience of Treatment of Severe Eosinophilic Asthma with IL-5 Antagonists; Mepolizumab and Reslizumab
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A1396 - A Real World, Single Center Experience of Treatment of Severe Eosinophilic Asthma with IL-5 Antagonists; Mepolizumab and Reslizumab
Author Block: R. Mylvaganam, L. Rogers; Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Rationale: Anti-Interleukin 5 (IL5) therapies reduce exacerbations and are oral glucocorticoid sparing in the treatment of severe eosinophilic asthma in clinical trials. Whether responses in clinical trials reflect outcomes in real world practice is unknown. We therefore assessed outcomes of patients with severe eosinophilic asthma treated with mepolizumab and reslizumab in our severe asthma program.
Methods: We evaluated demographic, clinical characteristics and treatment outcomes of all patients treated for severe eosinophilic asthma with anti IL5 from January 2015 to July 2017 at a single academic center. A clinical response to therapy was defined as either a 50% reduction in oral corticosteroid (OCS) dose or annualized exacerbation rate after at least 3 months of therapy. Demographic and clinical characteristics associated with treatment response were also assessed. All statistical analyses were performed using JMP Version 13 and PRISM Version 7.0c.
Results: Between January 2015 and July 2017, 37 patients initiated treatment with either mepolizumab (n=30) or reslizumab (n=7). A small group of patients were transitioned from mepolizumab to reslizumab due to an incomplete treatment response (n=4). Using a stringent definition of treatment response, there was no significant difference in response rates between mepolizumab and reslizumab (63% vs 67% respectively, p=0.85). Compared to mepolizumab responders, reslizumab responders weighed more (BMI 34 vs 28, p=0.019), and had a higher pre-treatment OCS dose (28 vs 12 mg, p=0.029). Of the 4 patients who crossed over from mepolizumab to reslizumab, 3 responded to reslizumab. There was no statistically significant difference in immediate pre-treatment or peak pre-treatment absolute eosinophil counts, immunoglobulin E levels, fraction of exhaled nitric oxide, or in atopic status between responders and non-responders of either anti-IL5 agent individually, or when outcomes for both agents were pooled.
Conclusions: In using a stringent definition of clinical response, we did not identify a difference in response rates between mepolizumab or reslizumab although patients treated with reslizumab had a higher BMI and mean pre-treatment OCS dose. A small group of patients who failed to respond to mepolizumab subsequently responded to reslizumab. We did not identify any demographic or clinical characteristics that predicted response to anti IL5 treatment.
Author Block: R. Mylvaganam, L. Rogers; Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Rationale: Anti-Interleukin 5 (IL5) therapies reduce exacerbations and are oral glucocorticoid sparing in the treatment of severe eosinophilic asthma in clinical trials. Whether responses in clinical trials reflect outcomes in real world practice is unknown. We therefore assessed outcomes of patients with severe eosinophilic asthma treated with mepolizumab and reslizumab in our severe asthma program.
Methods: We evaluated demographic, clinical characteristics and treatment outcomes of all patients treated for severe eosinophilic asthma with anti IL5 from January 2015 to July 2017 at a single academic center. A clinical response to therapy was defined as either a 50% reduction in oral corticosteroid (OCS) dose or annualized exacerbation rate after at least 3 months of therapy. Demographic and clinical characteristics associated with treatment response were also assessed. All statistical analyses were performed using JMP Version 13 and PRISM Version 7.0c.
Results: Between January 2015 and July 2017, 37 patients initiated treatment with either mepolizumab (n=30) or reslizumab (n=7). A small group of patients were transitioned from mepolizumab to reslizumab due to an incomplete treatment response (n=4). Using a stringent definition of treatment response, there was no significant difference in response rates between mepolizumab and reslizumab (63% vs 67% respectively, p=0.85). Compared to mepolizumab responders, reslizumab responders weighed more (BMI 34 vs 28, p=0.019), and had a higher pre-treatment OCS dose (28 vs 12 mg, p=0.029). Of the 4 patients who crossed over from mepolizumab to reslizumab, 3 responded to reslizumab. There was no statistically significant difference in immediate pre-treatment or peak pre-treatment absolute eosinophil counts, immunoglobulin E levels, fraction of exhaled nitric oxide, or in atopic status between responders and non-responders of either anti-IL5 agent individually, or when outcomes for both agents were pooled.
Conclusions: In using a stringent definition of clinical response, we did not identify a difference in response rates between mepolizumab or reslizumab although patients treated with reslizumab had a higher BMI and mean pre-treatment OCS dose. A small group of patients who failed to respond to mepolizumab subsequently responded to reslizumab. We did not identify any demographic or clinical characteristics that predicted response to anti IL5 treatment.
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