Historical Exacerbations May Predict Health Status in Severe Asthma

Patients with severe eosinophilic asthma with a higher rate of historical exacerbations had worse health status compared with patients with lower rates of historical exacerbations, according to study results published in the Journal of Asthma.

Researchers conducted a post hoc analyses of 3 randomized controlled trials (MUSCA; ClinicalTrials.gov Identifier: NCT02281318; MENSA; ClinicalTrials.gov Identifier: NCT01691521; and IDEAL; ClinicalTrials.gov Identifier: NCT02293265) that included patients with severe eosinophilic asthma to evaluate the effect of historical exacerbations on baseline total and domain St. George’s Respiratory Questionnaire (SGRQ) scores. Participants were randomly assigned to either mepolizumab or placebo in the MENSA and MUSCA trials. Historical exacerbations were defined as requiring treatment with systemic corticosteroids 12 months before enrollment in both the MENSA and MUSCA trials, and in the IDEAL trial, they were defined as requiring treatment with systemic corticosteroids and/or an emergency department visit and/or hospitalization in the 12 months before enrollment.

Of the 1755 patients with severe eosinophilic asthma included in the analyses, higher numbers of historical exacerbations were associated with worse baseline SGRQ total scores. In the MENSA and MUSCA studies, for each additional historical exacerbation beyond 2 exacerbations, there was an association of a worsening mean total SGRQ score at baseline (+1.5 and +1.1, respectively). In addition, each severe exacerbation experienced during the MESA or MUSCA studies was associated with a worsening total SGRQ score at the conclusion of each study (+2.4 and +3.4, respectively). Mepolizumab contributed to improvements in total SGRQ scores in both studies (-5.3 in MESA and -6.2 in MUSCA).

Meanwhile, in the IDEAL study, an additional exacerbation beyond the first exacerbation was associated with a worsening mean total SGRQ score at baseline (+2.3). Patients who reported no severe exacerbations had significantly lower (better) SGRQ total scores compared with patients who experienced ≥1 severe exacerbation before enrollment (difference, -9.7 points). 

The main limitation of these analyses was that the definition of asthma severity included the presence of exacerbations, as well as an outcome, which makes it difficult to determine causality of changes in health status independent of exacerbations.

“Although exacerbations are considered to be acute episodes, the results presented indicate that frequent exacerbations in patients with severe asthma lead to long-term impacts on health status,” the researchers noted.

Disclosure: These clinical trials were supported by GlaxoSmithKline. Please see the original reference for a full list of authors’ disclosures.

Reference

Nelson L, Cockle SM, Gunsoy NB, et al. Impact of exacerbations on St George’s Respiratory Questionnaire score in patients with severe asthma: post hoc analyses of two clinical trials and an observational study [published June 28, 2019]. J Asthma. doi:10.1080/02770903.2019.1630640