Mepolizumab Reduces Exacerbations in Patients With Severe Asthma, Concurrent COPD, Posters Find

Two posters presented at the CHEST 2024 annual meeting in Boston, Massachusetts, demonstrate that mepolizumab significantly reduces exacerbations in patients with severe asthma and those with asthma and concurrent chronic obstructive pulmonary disease (COPD).

Mepolizumab significantly reduces exacerbations in patients with severe asthma and asthma with concurrent chronic obstructive pulmonary disease (COPD). | Image Credit: DALU11 - stock.adobe.com

Mepolizumab is a humanized anti–IL-5 monoclonal antibody that has demonstrated efficacy in clinical trials and is approved for treating severe asthma with an eosinophilic phenotype.¹

Mepolizumab Use in Patients With Asthma and Concurrent COPD

The first poster assessed the real-world impact of mepolizumab initiation in patients with asthma and concurrent COPD, a condition observed in about 20% to 25% of patients with asthma.¹

The researchers analyzed real-world data from the Komodo Research database, a US claims database, spanning January 2016 to June 2023. Eligible patients were at least 12 years old and had at least 2 records of mepolizumab use; the first observed treatment date was considered the index date. Additionally, eligible patients needed at least 12 months of continuous insurance coverage pre– and post index date.

They defined patients with at least 1 asthma diagnosis and at least 1 COPD diagnosis in the 12 months before the index date as patients with asthma and concurrent COPD. Conversely, those with only an asthma diagnosis were defined as “asthma-only” patients. 

The main outcome was to assess annualized COPD exacerbation rates. This included moderate exacerbations, which the researchers defined as a COPD-related outpatient/emergency department (ED) visit requiring the dispensing of systemic corticosteroids or guideline-recommended antibiotics.

The researchers also analyzed severe exacerbations, which they defined as COPD-related inpatient hospitalization. Additionally, they assessed asthma-related exacerbations, defined as either an outpatient visit for asthma requiring the dispensing of systemic corticosteroids or an asthma-related inpatient admission/ED visit.

Consequently, the researchers identified 2106 patients with asthma and concurrent COPD, the mean (SD) age being 56.6 (12.1) years. They also identified 4674 asthma-only patients, the mean (SD) age being 46.2 (15.5) years.

Among those with asthma and concurrent COPD, the mean (SD) annual COPD exacerbation rate pre–mepolizumab initiation was 1.88 (1.96) overall and 2.80 (1.99) in the subgroup of patients with 1 or more COPD exacerbation at baseline.

However, the mean (SD) annual COPD exacerbation rate post mepolizumab initiation decreased by 55% in the overall patient group (rate ratio, 0.45; 95% CI, 0.41-0.48; P < .001). In the patient subgroup, the rate decreased by 59% (rate ratio, 0.41; 95% CI, 0.38-0.44; P < .001).

As for severe COPD exacerbations, the annualized rate decreased by 52% (rate ratio, 0.48; 95% CI, 0.41-0.56; P < .001) in the overall patient group and 54% (rate ratio, 0.46; 95% CI, 0.39-0.54; P < .001) in the patient subgroup. Similarly, the researchers observed significant asthma exacerbation reductions in both patients with asthma and concurrent COPD (rate ratio, 0.50; 95% CI, 0.47-0.52; P < .001) and asthma-only patients (rate ratio, 0.51; 95% CI, 0.49-0.53; P < .001).

“This supports the use of mepolizumab in patients that have asthma, as well as those with comorbid COPD," presenter Emmeline Igboekwe, PharmD, senior director and medical lead at GSK, told The American Journal of Managed Care^® (AJMC^®). "These patients are often excluded from studies for asthma or for COPD despite significant health care resource utilization, which drives up overall health care costs."

Mepolizumab vs Benralizumab

Similarly, the second poster found that using mepolizumab to treat patients with asthma resulted in significantly fewer exacerbations compared with benralizumab.²

The researchers explained that monoclonal antibodies have been developed to target type 2 inflammatory pathways, which help to achieve effective control of asthma symptoms and prevent exacerbations. For example, mepolizumab and benralizumab, an IL-5 receptor inhibitor, are approved to treat patients with severe asthma and an elevated blood eosinophil count.

Therefore, they conducted a retrospective chart review to compare how effective these 2 agents are at preventing asthma exacerbations. Using an electronic medical record system, the researchers analyzed a cohort of 92 and 81 patients who were started on benralizumab and mepolizumab, respectively.

Exacerbations were observed in 60 (65%) patients receiving benralizumab and 32 (39%) patients receiving mepolizumab (P = .001). Conversely, the number of exacerbations among patients on daily oral corticosteroids was similar within the benralizumab (31%) and mepolizumab (33%) groups.

Exacerbations occurred within 5 months of treatment initiation in 36% of the benralizumab group and 40% of the mepolizumab group. However, exacerbations occurred between 11 and 15 months of treatment initiation in 5% of the benralizumab group and 3% of the mepolizumab group. Therefore, the researchers noted that patients tend to exacerbate more often in the early phase of treatment.

However, presenter Sanjana Ramakrishnan, an internal medicine resident at Rochester Regional Health, told AJMC that factors like inhaler compliance, comorbidities, and baseline eosinophil count before treatment initiation must be investigated within the 2 groups.

“I’m not saying that one is better than the other [mepolizumab vs benralizumab]; I think these factors need to be looked into to actually say that,” she said.

Overall, these posters emphasized mepolizumab’s consistency in reducing exacerbations in different patient populations, with the potential for better long-term control of asthma and concurrent COPD.

References

1. Bhatt SP, Yang S, Germain G, et al. Mepolizumab reduces exacerbations in patients with concurrent diagnosis of asthma and chronic obstructive pulmonary disease: a US claims analysis. Poster presented at: CHEST Annual Meeting 2024; October 6-9, 2024; Boston, MA. doi:10.1016/j.chest.2024.06.2935
2. Ramakrishnan S, Lyons JJ, Renjith KM, Misbah A, Al-Hiti Z. Comparing asthma exacerbation between benralizumab vs mepolizumab in severe asthma. Poster presented at: CHEST Annual Meeting 2024; October 6-9, 2024; Boston, MA. doi:10.1016/j.chest.2024.06.063