Mepolizumab Effective in Asthma After Failed Response to Omalizumab

This article is part of Pulmonology Advisor‘s coverage of the American Academy of Allergy, Asthma & Immunology, taking place in Orlando, Florida. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI/WAO 2018.

ORLANDO — Mepolizumab may be effective in patients with asthma that does not respond to omalizumab, according to data presented at the 2018 Joint Congress of the American Academy of Allergy, Asthma & Immunology, held March 2-5, in Orlando, Florida.

Geetika Sabharwal, MD, from Penn State Health Milton S. Hershey Medical Center in Camp Hill, Pennsylvania, and Faoud Terrence Ishamel, MD, PhD, from Penn State College of Medicine in Hershey, conducted a retrospective analysis of patients with asthma who were treated with mepolizumab 100 mg subcutaneous every 4 weeks to determine the phenotypic features of mepolizumab responders and whether mepolizumab was effective in patients with asthma that did not respond to omalizumab. 

Patients were considered treatment responders if they experienced ≥5% increase in forced expiratory volume in 1 second (FEV₁), an increase in Asthma Control Test (ACT) score ≥3 points, or a ≥50% reduction in albuterol use.

Of the total 27 patients, 15 patients had not received treatment with a monoclonal antibody, and 12 patients had been treated with omalizumab without response. Response was seen in 20 patients treated with mepolizumab. Prior to treatment, these patients had a mean ACT score of 10.2± 5.6 and mean FEV₁% of 54.3%±16.9%. After treatment, the mean ACT score was 18.3±6.3 and mean FEV₁% was 63.2%±16.7% (P =.016 and P =.018, respectively).

Apart from younger age (12.4±21 years vs 22±22 years; P =.21), patients with asthma that did not respond to mepolizumab did not differ from those with asthma that did respond with regard to specific immunoglobulin E, blood eosinophil level, or lung function. However, mean body mass index was lower in patients with asthma that responded to treatment compared with those with asthma that did not: 32±6 kg/m² vs 48±14 kg/m² (P =.019).

Of the 12 patients treated with omalizumab without response, 9 met the criteria for response to mepolizumab: ACT, 10.1±6.8 vs 17.4±17.7 (P =.037) and FEV₁, 1.44±0.30 vs 1.60±0.31 (P =.078).

Although no specific predictors were identified for mepolizumab response, higher body mass index may be a negative predictor for response after failed omalizumab response. The researchers suggested that better biomarkers are needed to predict response in both medications.

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Reference

Sabharwal G, Ishmael F. Characteristics of asthmatic responders to mepolizumab after failed response to omalizumab. Presented at: 2018 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress; March 2-5, 2018; Orlando, FL. Poster 48.