Background: REMIT is the first real-world study of mepolizumab effectiveness in patients with severe asthma (SA) in Taiwan.
Objectives: The primary objective evaluated changes in clinically significant exacerbations (CSEs; defined as use of oral corticosteroids (OCS) or emergency department (ED) visits and/or hospitalizations) in the 12 months pre- and post-mepolizumab treatment. Secondary objectives assessed changes in the number of CSEs requiring ED visits/hospitalizations and daily maintenance OCS (mOCS) dosage 12 months pre- and post-mepolizumab treatment. Three- and four-component clinical remissions were analyzed based on OCS-free, exacerbation-free, and asthma control (± stability in lung function).
Design: REMIT was a retrospective, observational, self-controlled study analyzing patients in Taiwan with SA who were newly prescribed subcutaneous mepolizumab 100 mg Q4W.
Methods: Data were extracted from records of 15 medical centers in Taiwan for patients indexed between November 1, 2018 and October 31, 2020.
Results: A total of 170 patients were included: mean age at index date, 58.7 years; 53.5% female; 100% Chinese; 7.1% with chronic rhinosinusitis with nasal polyps, 1.8% with eosinophilic granulomatosis with polyangiitis, 1.2% with hypereosinophilic syndrome; and 55.7% with blood eosinophil count >300/µL. Pre-treatment, 71.2% had ⩾2 exacerbations, and 28.7% were on mOCS; 75.3% had no prior biologic treatment, and 24.7% had switched from other biologics. Most patients (80.0%) completed ⩾10 mepolizumab doses. Following the first mepolizumab administration (index date), CSEs reduced by 46.0% (rate ratio (RR): 0.545, 95% confidence interval (CI): 0.418-0.710; p < 0.0001) in the 12 months post-index. Exacerbations requiring ED visits/hospitalization reduced by 46.9% (RR: 0.531, 95% CI: 0.349-0.808; p = 0.0031). Median mOCS dose reduced by 100% by end of study and 81.8% of patients discontinued mOCS post-treatment. After 1 year of mepolizumab treatment, 28% and 23% patients achieved three- and four-component clinical remission, respectively.
Conclusion: Mepolizumab use in a patient population in Taiwan with SA significantly reduced CSEs and mOCS use in routine clinical practice.
Keywords: Taiwan; eosinophil; exacerbation; interleukin-5; severe asthma with eosinophilic phenotype.
Mepolizumab for the treatment of severe asthma in TaiwanWhy was the study done?• Patients with severe asthma can experience flare-ups, when symptoms become worse than usual and may require extra treatment• Severe asthma is often treated with corticosteroids, which are oral medications (not inhalers) that can reduce asthma flare-ups, but with side effects that can impact patients’ quality of life• Mepolizumab is a promising treatment for severe asthma. Clinical trials have shown that mepolizumab reduces flare-ups and corticosteroid use in patients with severe asthma, reducing corticosteroid side effects• We wanted to know how well mepolizumab controls severe asthma in Chinese patients in clinical practiceWhat did we do?• We looked at data from 170 patients with severe asthma in Taiwan who were given mepolizumab for the first time, with injections once every 4 weeks• We compared the number of flare-ups 1 year before treatment with mepolizumab to the number of flare-ups after 1 year of mepolizumab• After 1 year of mepolizumab, we looked at:○ Changes in flare-ups by measuring corticosteroid use and number of emergency department visits/hospitalizations○ Whether patients reached high level disease control (known as remission), which is when a patient does not need corticosteroids, does not experience flare-ups, has no severe asthma symptoms, and/or has no changes in lung functionWhat did we find?• We found that, after taking mepolizumab:○ The average number of flare-ups in patients was almost halved○ The number of flare-ups needing emergency department visits/hospitalizations was reduced by nearly half○ All patients stopped taking their regular daily corticosteroids. More than three quarters of patients stopped using any corticosteroids○ 28% of patients met 3 of the remission criteria, 23% met all 4 criteriaWhat do the findings mean?• In Chinese patients with severe asthma, mepolizumab is effective at reducing flare-ups and corticosteroid use, helping patients achieve remission.