• Erin S Harvey, David Langton, Constance Katelaris, Sean Stevens, Claude S Farah, Andrew Gillman, John Harrington, Mark Hew, Vicky Kritikos, Naghmeh Radhakrishna, Philip Bardin, Matthew Peters, Paul N Reynolds, John W Upham, Melissa Baraket, Simon Bowler, Jeffrey Bowden, Jimmy Chien, Li Ping Chung, Christopher Grainge, Christine Jenkins, Gregory P Katsoulotos, Joy Lee, Vanessa M McDonald, Helen K Reddel, Janet Rimmer, Wark Peter A B PAB 0000-0001-5676-6126 Centre of Excellence in Severe Asthma and Priority Research Centre for Healthy Lungs, Faculty of Health, Univer, and Peter G Gibson.
• Centre of Excellence in Severe Asthma and Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Newcastle, Australia.
• Eur. Respir. J. 2020 May 1; 55 (5).

AbstractSevere asthma is a high-burden disease. Real-world data on mepolizumab in patients with severe eosinophilic asthma is needed to assess whether the data from randomised controlled trials are applicable in a broader population.The Australian Mepolizumab Registry (AMR) was established with an aim to assess the use, effectiveness and safety of mepolizumab for severe eosinophilic asthma in Australia.Patients (n=309) with severe eosinophilic asthma (median age 60 years, 58% female) commenced mepolizumab. They had poor symptom control (median Asthma Control Questionnaire (ACQ)-5 score of 3.4), frequent exacerbations (median three courses of oral corticosteroids (OCS) in the previous 12 months), and 47% required daily OCS. Median baseline peripheral blood eosinophil level was 590 cells·µL-1 Comorbidities were common: allergic rhinitis 63%, gastro-oesophageal reflux disease 52%, obesity 46%, nasal polyps 34%.Mepolizumab treatment reduced exacerbations requiring OCS compared with the previous year (annualised rate ratio 0.34 (95% CI 0.29-0.41); p<0.001) and hospitalisations (rate ratio 0.46 (95% CI 0.33-0.63); p<0.001). Treatment improved symptom control (median ACQ-5 reduced by 2.0 at 6 months), quality of life and lung function. Higher blood eosinophil levels (p=0.003) and later age of asthma onset (p=0.028) predicted a better ACQ-5 response to mepolizumab, whilst being male (p=0.031) or having body mass index ≥30 (p=0.043) predicted a lesser response. Super-responders (upper 25% of ACQ-5 responders, n=61, 24%) had a higher T2 disease burden and fewer comorbidities at baseline.Mepolizumab therapy effectively reduces the significant and long-standing disease burden faced by patients with severe eosinophilic asthma in a real-world setting.Copyright ©ERS 2020.

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