Long-term real-world outcomes of mepolizumab and benralizumab among biologic-naïve patients with severe eosinophilic asthma: experience of three years’ therapy

Background

Biological therapies, such as mepolizumab and benralizumab, offer treatment options for severe eosinophilic asthma (SEA), although long-term real-world data on their use are limited.

Objective

Evaluate the impact of benralizumab/mepolizumab treatment among biologic-naïve patients with SEA over 36 months Describe the incidence of super-response at 12 and 36 months, identifying potential predictive factors.

Methods

Retrospective, single-centre study of patients with SEA started on mepolizumab/benralizumab from May 2017–December 2019 who completed 36 months of therapy. Baseline demographics , co-morbidities, and medication use were described. Clinical outcomes, including maintenance oral corticosteroid (mOCS) use, annual exacerbation rate (AER), mini Asthma Quality of Life Questionnaire (mAQLQ), Asthma Control Questionnaire (ACQ-6), and eosinophil count (EC), were collected at baseline, 12 months, and 36 months. Super-response was evaluated at 12 and 36 months.

Results

81 patients were included. mOCS use significantly improved from baseline (5.3mg/day) to 12 months (2.4mg/day, p<0.0001) and 36 months (0.6mg/day, p<0.0001). AER reduced from baseline (5.8) to 12 months (0.9, p<0.0001) and 36 months (1.2, p<0.0001). mAQLQ, ACQ-6, and EC significantly improved from baseline to 12 and 36 months. 29 patients demonstrated super-response at 12 months; compared to those without super-response these patients had better baseline AER (4.7 v 6.5, p=0.009), mAQLQ (3.41 v 2.54, p=0.002), and ACQ-6 (3.38 v 4.06, p=0.03). The majority maintained super-response to 36 months.

Conclusion

Mepolizumab and benralizumab are associated with significant improvements in OCS use, AER, and asthma control in real-world cohorts for up to 36 months, providing insight into long-term use for SEA.