An evaluation of mepolizumab for the treatment of severe asthma

Expert Opin Biol Ther. 2019 Jun;19(6):491-500. doi: 10.1080/14712598.2019.1610382. Epub 2019 May 7.

Abstract

Introduction: Asthma is considered one of the most common chronic conditions globally, characterized by variable airflow obstruction and symptoms. Severe asthma is diagnosed when asthma control requires high-intensity therapy or continues to remain uncontrolled despite treatment. Eosinophilic inflammation is known to be perpetuated by the activity of IL-5 in a proportion of severe asthma subjects, and targeting IL-5 may offer a therapeutic option. Areas covered: In this review, we discuss the role and pathogenesis of IL-5 and eosinophils in asthma and rationale of antagonizing IL-5 in severe eosinophilic asthma. Mepolizumab is the first of three anti-IL-5 biologics licensed in 2015 for use in this subgroup of patients. We discuss clinical and real-life studies leading up to its approval and post-marketing outcomes in terms of efficacy and safety to-date, as well as its pros and cons. Expert opinion: IL-5 antagonism has paved the way for an additional personalized therapeutic opportunity for use in severe asthma with eosinophilic inflammation, though there is limited evidence on the long-term implications of suppressing/depleting eosinophils and the duration for which they should be administered.

Keywords: Severe asthma; anti-Il-5 therapies; biologics; eosinophilic asthma; mepolizumab.

Publication types

  • Review

MeSH terms

  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Asthma / drug therapy*
  • Asthma / pathology
  • Clinical Trials as Topic
  • Eosinophils / cytology
  • Eosinophils / immunology
  • Eosinophils / metabolism
  • Humans
  • Immunoglobulin E / immunology
  • Interleukin-5 / immunology
  • Interleukin-5 / metabolism
  • Nasopharyngitis / etiology
  • Omalizumab / therapeutic use

Substances

  • Antibodies, Monoclonal, Humanized
  • Interleukin-5
  • Omalizumab
  • Immunoglobulin E
  • mepolizumab