Comorbidities Modify the Phenotype but Not the Treatment Effectiveness to Mepolizumab in Severe Eosinophilic Asthma.

Autor:	Kritikos V; Clinical Management Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia., Harvey ES; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia., Stevens S; School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia., Katelaris CH; Immunology and Allergy Unit, Campbelltown Hospital, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia., Langton D; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Department of Thoracic Medicine, Frankston Hospital, Melbourne, VIC, Australia., Rimmer J; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; Department of Thoracic Medicine, St Vincent's Clinic, Sydney, NSW, Australia., Farah CS; Department of Thoracic Medicine, Concord Hospital, Sydney, NSW, Australia., Gillman A; Allergy, Asthma and Clinical Immunology Clinic, Alfred Health, Melbourne, VIC, Australia., Hew M; Allergy, Asthma and Clinical Immunology Clinic, Alfred Health, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia., Radhakrishna N; Respiratory Department, St Vincent's Hospital, Melbourne, VIC, Australia., Thomas D; School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia., Gibson PG; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia. Electronic address: peter.gibson@health.nsw.gov.au.
Jazyk:	angličtina
Zdroj:	The journal of allergy and clinical immunology. In practice [J Allergy Clin Immunol Pract] 2023 Mar; Vol. 11 (3), pp. 885-895.e13. Date of Electronic Publication: 2022 Dec 23.
DOI:	10.1016/j.jaip.2022.12.004
Abstrakt:	Background: Comorbidities in severe asthma are common and contribute to disease burden. The severe asthma phenotype and treatment response can be impacted by comorbid conditions. Real-world data on the use of mepolizumab in severe eosinophilic asthma (SEA) in the presence of comorbidities are needed to inform clinical practice. Objective: To investigate the impact of comorbid conditions on baseline phenotype in patients with SEA and assess the mepolizumab treatment effect by comorbidity status in SEA. Methods: Patients enrolled in the Australian Mepolizumab Registry (n = 309) were classified into subgroups defined by the presence or absence of comorbidities, including nasal polyps, aspirin-exacerbated airway disease, asthma-chronic obstructive pulmonary disease overlap (ACO), fungal sensitization, and obesity. Patient baseline characteristics were compared, and the impacts of comorbidity on phenotype, identified by differences in patient age and/or baseline biomarker levels and/or asthma severity, were assessed. The mepolizumab treatment effects on clinical and biological outcomes at 12 months were assessed. Results: Across comorbidity subgroups, mepolizumab reduced the rate of clinically significant exacerbations (range: 47%-77%), maintenance oral corticosteroid use (dose reduction: 4.2-13.3 mg/d), and improved symptom control (Asthma Control Questionnaire-5 score: 1.9-2.4 point reduction) and lung function (mean: 3.4-9.3 post-bronchodilator percent predicted forced expiratory volume in 1 second). Peripheral blood eosinophils were reduced (mean: 480-780 cells/μL). Comorbidities (nasal polyps, obesity, ACO, and fungal sensitization) modified the baseline phenotype. Conclusions: Mepolizumab treatment is associated with comparable clinical improvements in patients with SEA and comorbidities. Mepolizumab effectively minimizes the disease impact and corticosteroid burden in patients with SEA. (Copyright © 2023. Published by Elsevier Inc.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu