A meta-analysis of exacerbations requiring hospitalization from studies of mepolizumab in severe eosinophilic asthma

INTRODUCTION:

Studies with mepolizumab have confirmed an approximately 50% reduction in exacerbations requiring oral steroids in patients with severe eosinophilic asthma compared to placebo (standard of care). Exacerbations requiring hospitalization or emergency room (ER) visits are even more serious, but are difficult to study in a single randomized controlled clinical trial as they occur relatively infrequently. As these outcomes are particularly important to patients and healthcare practitioners, we conducted an individual patient data meta-analysis to compare the effect of mepolizumab with placebo on exacerbations requiring hospitalization and on exacerbations requiring ER visits or hospitalization.

METHODS:

We identified two randomized, double-blind, placebo-controlled studies of mepolizumab in severe eosinophilic asthma, where maintenance dose of oral steroids was kept constant and which used the 100mg SC dose or the corresponding 75mg IV dose of mepolizumab. For analysis purposes, these two treatment arms were combined.

RESULTS:

Meta-analysis results are shown in the Table. The rate of exacerbations requiring hospitalization was reduced by approximately 50% for patients on mepolizumab compared with those on placebo. Similar statistically significant reductions were seen for the rate of exacerbations requiring ER visit/hospitalization.