NEW ORLEANS — Irrespective of the type and number of background controller therapies, mepolizumab consistently reduced the annual rate of exacerbations in severe eosinophilic asthma compared with placebo, according to research presented at the CHEST Annual Meeting, held October 19 to 23, 2019, in New Orleans, Louisiana.

Although the MENSA ( Identifier: NCT01691521) and MUSCA ( Identifier: NCT02281318) clinical trials showed a consistent reduction in the annual rate of severe eosinophilic asthma exacerbation when mepolizumab was added to standard of care (high-dose inhaled corticosteroids [ICS] plus ≥1 controller therapy), MENSA is the only trial that investigated mepolizumab’s effect on the exacerbation rate according to the type and number of background controller therapies.

This post hoc subgroup meta-analysis investigated the annual rate of clinically significant exacerbations (defined as requiring systemic glucocorticoids for ≥3 days or an emergency department visit/hospitalization) in patients with eosinophilic asthma taking 100 mg subcutaneous mepolizumab or placebo according to background controller therapy number and type (ICS plus 1 controller, ICS plus 2 controllers, or ICS plus ≥3 controllers). Exacerbation rates were assessed at week 24 for MUSCA and week 32 for MENSA. In the meta-analysis, negative binomial regression and treatment differences were combined across studies using fixed-effects inverse-variance weighted meta-analysis.

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Of the total 936 patients, 59% (n=556) were on ICS plus 1 controller, 27% (n=252) were on ICS plus 2 controllers, and 12% (n=117) were on ICS plus ≥3 controllers. Reductions in clinically relevant exacerbations were observed with 100 mg subcutaneous mepolizumab compared with placebo (rate ratio [mepolizumab/placebo] for ICS plus 1 controller, 0.40[95% CI, 0.29-0.56]; ICS plus 2 controllers, 0.52 [95% CI, 0.36-0.74]; and ICS plus ≥3 controllers, 0.42 [95% CI, 0.27-0.66]). These reductions were also observed irrespective of controller type (rate ratio for mepolizumab/placebo: ICS/LABA plus another [not tiotropium], 0.50 [95% CI, 0.34-0.73]; ICS/LABA plus tiotropium, 0.36 [95% CI, 0.20-0.66]).

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The researchers concluded, “This study demonstrates that mepolizumab could be a useful treatment option for patients with severe eosinophilic asthma, regardless of the number and type of background standard of care medications.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Carstens D, Liu M, Mitchell P, et al. Effect of mepolizumab on exacerbations according to number and type of background controller therapies: meta-analysis from two phase 3 trials. Presented at: CHEST Annual Meeting 2019; October 19-23, 2019; New Orleans, LA. Abstract 1739.