Title: Efficacy Of Mepolizumab In Patients With Severe Eosinophilic Asthma And Nasal Polyps
Abstract: Severe eosinophilic asthma (SEA) and nasal polyps (NP) are characterized by eosinophilic inflammation. Mepolizumab is an approved treatment for SEA, it is of interest to understand the efficacy of mepolizumab in patients with SEA and co-existing NP. This was a meta-analysis of DREAM (NCT01000506) and MENSA (NCT01691521), which assessed the efficacy of mepolizumab versus placebo in patients with SEA with or without NP at baseline. The primary endpoint of this meta-analysis was the annual rate of clinically significant exacerbations. Secondary endpoints included pre- and post-bronchodilator FEV1, Asthma Control Questionnaire (ACQ-5), and St George's Respiratory Questionnaire (SGRQ; MENSA only). Data from both studies were combined using an inverse-variance weighted fixed-effects meta-analysis. Data are presented for combined 75 mg intravenous and 100 mg subcutaneous mepolizumab doses. A total of 884 patients were included in this analysis, of whom 120 (14%) had NP at baseline. Patients with NP had higher blood eosinophil counts at baseline than patients without NP (geometric mean (SD log): 380 (0.954) vs 260 (1.000) cells/μL, respectively). The reduction in exacerbations with mepolizumab compared with placebo was 59% for patients with NP (rate ratio [95% CI]: 0.41 [0.25–0.67]) and 48% for patients without NP (0.52 [0.42–0.64]). Mepolizumab improved ACQ-5, SGRQ, pre- and post-bronchodilator FEV1versus placebo in both groups, with larger point estimates in the NP group. Efficacy of mepolizumab was not affected by the presence of NP, making it a viable treatment option for patients with concurrent SEA and NP. Funded by GSK (205786).