Mepolizumab treatment of Medicare patients with severe eosinophilic asthma reduced exacerbation frequency, oral corticosteroid (OCS) use, and asthma exacerbation-related health care costs, according to an analysis of Medicare claims data published in The Journal of Allergy and Clinical Immunology: In Practice.
Investigators assessed the effects of initiating treatment with mepolizumab — an anti-interleukin-5 monoclonal antibody — among US Medicare patients with asthma. The primary endpoint was the change in the proportion of patients experiencing asthma exacerbations. Secondary endpoints included changes in OCS use and asthma exacerbation-related costs.
The researchers conducted a retrospective cohort study of the CMS Medicare database that included 1278 patients (mean [SD] age, 67.9 [10.6] years; 64.3% women) with a mepolizumab index date (ie, date of first claim for mepolizumab) between January 2017 and December 2017. The “baseline period” was defined as the 12 months pre-index date and the “follow-up period” was defined as the 12 months post-index date. Exclusion criteria included patients with at least 1 prescription for mepolizumab during the baseline period, or at least 1 prescription for omalizumab, reslizumab, benralizumab, or dupilumab during the baseline or follow-up period. Most common comorbidities included hypertension (75%), chronic obstructive pulmonary disease (69%), allergic rhinitis (62%), and gastroesophageal reflux disease (56%).
Investigators found a significant relative reduction (27%; P <.0001) in the proportion of patients with an asthma exacerbation during the follow-up vs baseline period. Asthma exacerbations were defined as an outpatient or emergency room claim with an asthma diagnosis and at least 1 claim for systemic corticosteroids within 5 days of that visit, or a hospital admission with primary diagnosis of asthma.
A significantly lower proportion of patients received OCS (16% relative reduction; P <.0001) during the follow-up vs baseline period. Fewer patients were chronic OCS users (≥5mg/day) during the follow-up vs baseline period (48% relative reduction; P <.0001). A significant decrease in asthma-exacerbation-related costs (total reduction $888.00; P =.0002) was observed during follow-up vs baseline.
Study limitations include lack of accounting for disease progression, changes in patient characteristics, or changes in treatment; the lack of clinical evaluation data of patients analyzed; lack of confirmation that those prescribed mepolizumab actually used it; and non-inclusion of the cost of mepolizumab in pharmacy cost data.
Investigators concluded that among US Medicare patients with asthma in a real-world setting, “treatment with mepolizumab was likely to result in fewer exacerbations, reductions in OCS use, and cause a reduction in exacerbation-related healthcare costs.” They added that “Our study suggests that in carefully selected elderly patients with severe asthma, anti-IL5 biologic therapy with drugs such as mepolizumab could be of benefit and should be considered.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
This research was supported by GlaxoSmithKline.
Sethi S, Bogart M, Corbridge T, Cyhaniuk A, Hahn B. Impact of mepolizumab on exacerbations in the US Medicare population. J Allergy Clin Immunol Pract. Published online October 27, 2022. doi:10.1016/j.jaip.2022.10.021