Mepolizumab reduces oral corticosteroid use across distinct severe asthma phenotypes: 2-year REALITI-A study

Oral corticosteroids (OCS) remain widely used in the treatment of severe asthma despite their adverse effects. Add-on biologic therapy offers the potential for minimizing OCS exposure.

This post hoc analysis of REALITI-A assessed the effect of mepolizumab on OCS use among subgroups of patients with severe asthma based on allergic/omalizumab-eligible phenotype and type-2 biomarker status.

REALITI-A was a prospective 2-year observational study among adults initiating mepolizumab for severe asthma. Endpoints assessed at 2 years were: change from baseline in daily maintenance OCS (mOCS) and total OCS dose, the proportion of patients discontinuing mOCS, the proportion of patients with 0 mg/day daily mOCS and total OCS dose, Asthma Control Questionnaire-5 scores, and clinically significant exacerbations. Outcomes were stratified by prior omalizumab use, omalizumab eligibility, baseline blood eosinophil count (threshold [<300/≥300 cells/μL] and category [<150/≥150-<300/≥300-<500/≥500 cells/μL]), baseline immunoglobulin E (IgE; <60/≥60-<190/≥190-<550/≥550 KU/L), atopic status (yes/no/unknown) and baseline fractional exhaled nitric oxide (FeNO; <25/≥25-<50/≥50 parts per billion).

Overall, 822 patients were included, with 39% receiving mOCS at baseline. For both mOCS and total OCS, median dose reductions after 2 years from baseline were 70-100% across all subgroups. Also, after 2 years, 44-71% of patients across subgroups had discontinued mOCS and 37-68% had 0 mg total OCS dose.

These data highlight mepolizumab's effectiveness in reducing real-world OCS use across a broad range of patients with severe asthma, irrespective of omalizumab eligibility and baseline blood eosinophil count, IgE, atopic status, and FeNO.