Oral corticosteroid-sparing effects of mepolizumab in severe eosinophilic asthma: evidence from randomized controlled trials and real-world studies

Abstract

Oral corticosteroids (OCS) have long been a mainstay of treatment for asthma exacerbations and chronic severe asthma. However, it is increasingly recognized that both long-term and short-term OCS use are directly associated with a wide range of serious adverse effects, and as such OCS-sparing treatment alternatives are now widely recommended for patients with severe asthma. While several international guidelines recommend these treatments, guidance on OCS tapering, and which patients are most likely to tolerate OCS reduction and/or discontinuation, is still lacking. Several biologics have demonstrated efficacy in patients with OCS-dependent asthma. One OCS-sparing treatment is the anti-interleukin-5 monoclonal antibody mepolizumab, which is approved for the treatment of severe eosinophilic asthma. In addition to improved exacerbation rates, asthma control, quality of life, and lung function among patients with severe eosinophilic asthma, mepolizumab also has an OCS-sparing effect, which has been demonstrated in randomized controlled trials and real-world studies. Both physicians and patients express concerns about the adverse effects of OCS, and additional data from the randomized, controlled SIRIUS trial (NCT01691508) highlight the high level of concern among patients regarding OCS-related burden. In this article, we discuss current guidance on OCS-sparing strategies for patients with severe asthma, provide a summary of the available evidence of the OCS-sparing effect of mepolizumab, and highlight patient and physician perspectives on the use of OCS and OCS-sparing treatments in severe asthma.

Real-world association between systemic corticosteroid exposure and complications in US patients with severe asthma

“…Outside of this study, it has been shown that healthcare costs are higher in SCS versus non-SCS users, with the costs associated with SCS-related complications increasing with SCS dose [ 5 – 9 ]. When combined with the adverse effects associated with SCS use, the higher healthcare costs among SCS users may be a further supporting factor for the use of SCS-sparing medications, such as biologics, in patients with severe asthma [ 16 , 19 , 20 , 22 , 24 ]. Furthermore, the cost effectiveness of biologic treatments has been demonstrated in a number of studies, particularly when treatment is targeted to specific responder populations [ 27 , 28 , 37 , 38 ].…”

“…Several biologic agents have been approved for the treatment of severe asthma, including omalizumab, reslizumab, tezepelumab, mepolizumab, benralizumab, and dupilumab [ 11 – 22 ]. These agents have demonstrated OCS-sparing effects both in clinical trials and in real-world settings [ 16 , 19 , 20 , 22 – 24 ]. While the cost effectiveness of biologics has been debated [ 25 ], and reductions in exacerbations requiring hospitalization are the primary driver of cost effectiveness with biologic therapy [ 26 , 27 ], chronic OCS reduction has also been reported to contribute to the lifetime discounted cost effectiveness of biologic therapy [ 28 ].…”

Expert consensus on the use of systemic glucocorticoids for managing eosinophil-related diseases

“…Thus, biologics are recommended before chronic SGC in uncontrolled patients (72). Despite the proven reduction in exacerbation rates and SGC-sparing effects in real-life studies (73,74), biologics are still underprescribed in most regions in Spain (75,76).…”