Real-World Multicenter Experience with Mepolizumab and Benralizumab in the Treatment of Uncontrolled Severe Eosinophilic Asthma Over 12 Months

Moritz Z Kayser; Nora Drick; Katrin Milger; Jan Fuge; Nikolaus Kneidinger; Stephanie Korn; Roland Buhl; Jürgen Behr; Tobias Welte; Hendrik Suhling

doi:10.2147/JAA.S319572

Real-World Multicenter Experience with Mepolizumab and Benralizumab in the Treatment of Uncontrolled Severe Eosinophilic Asthma Over 12 Months

J Asthma Allergy. 2021 Jul 12:14:863-871. doi: 10.2147/JAA.S319572. eCollection 2021.

Authors

Moritz Z Kayser¹, Nora Drick¹, Katrin Milger^{2

3}, Jan Fuge^{1

4}, Nikolaus Kneidinger^{2

3}, Stephanie Korn⁵, Roland Buhl⁶, Jürgen Behr^{2

3}, Tobias Welte^{1

4}, Hendrik Suhling¹

Affiliations

¹ Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
² Department of Medicine V, University Hospital, LMU, Munich, Germany.
³ Comprehensive Pneumology Center-Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
⁴ Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.
⁵ Clinical Research Centre for Respiratory Medicine, Mainz, Germany.
⁶ Pulmonary Department, Mainz University Hospital, Mainz, Germany.

Abstract

Purpose: Treatment of severe eosinophilic asthma (SEA) has been revolutionized by the development of monoclonal antibodies targeting underlying immunological pathways of eosinophilic asthma. Two of the most frequently used antibodies in clinical practice are mepolizumab, targeting interleukin (IL) 5 and benralizumab, targeting the IL5 receptor alpha. The comparative treatment efficacy of these antibodies remains unclear, particularly regarding long-term outcomes.

Patients and methods: In this multicenter, retrospective study, we included 123 patients treated with mepolizumab and 64 patients treated with benralizumab for 12 months at one of three study sites in Germany. Data were collected at baseline and after 6 and 12 months of therapy. Endpoints were changes in pulmonary function (PF), exacerbation rate, oral corticosteroid (OCS) use and dose, asthma control test (ACT) score and fractional exhaled nitric oxide (FeNO) levels.

Results: Both mepolizumab and benralizumab led to significant improvements in PF with an increase in median forced expiratory volume (FEV1) after 12 months from 59% to 74% for mepolizumab and 63% to 72% for benralizumab. Treatment also led to significant improvements in ACT scores after 12 months (mepolizumab: 13 [interquartile range (IQR) 9-17] to 19 [IQR 15-23]; benralizumab: 12 [IQR 9-16] to 22 [IQR 16-25]) as well as a reduction of mean OCS dose (mepolizumab 8 mg [IQR 5-12.5 mg] median prednisolone equivalent at baseline to 5 mg [IQR 3-7.5 mg]; benralizumab 7.5 mg [IQR 5-15 mg] to 5 mg [IQR 2-10 mg]). The exacerbation rates were reduced significantly, irrespective of the treatment. Overall, changes were similar after 6 and 12 months of therapy.

Conclusion: Both mepolizumab and benralizumab are highly effective in the long-term treatment of SEA, with no clinically relevant differences in outcomes after 12 months of therapy. In both groups, improvements were similar after 6 and 12 months of therapy, underlining the feasibility of early treatment evaluation.

Keywords: asthma control; interleukin-5; interleukin-5-receptor; lung; severe eosinophilic asthma; treatment response.