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Oral corticosteroids (OCS) carry serious health risks. Innovative treatment options are required to reduce excessive exposure and promote OCS stewardship. This study evaluated the trajectories of OCS exposure (prednisolone-equivalent) in patients with severe eosinophilic asthma before and after starting mepolizumab and the predictors of becoming OCS free after 6 months of mepolizumab therapy. This real-world observational study included 309 patients from the Australian Mepolizumab Registry who were followed up for 1 year (n = 225). Patients had a median age of 60 (interquartile range: 50, 68) years, and 58% were female. At baseline, 48% used maintenance OCS, 96% had ≥1 OCS burst, and 68% had received ≥1 g of OCS in the previous year. After commencing mepolizumab, only 55% of those initially on maintenance OCS remained on this treatment by 12 months. Maintenance OCS dose reduced from median 10 (5.0, 12.5) mg/day at baseline to 2 (0, 7.0) mg/day at 12 months (P < .001). Likewise, proportions of patients receiving OCS bursts in the previous year reduced from 96% at baseline to 50% at 12 months (P < .001). Overall, 137 (48%) patients required OCS (maintenance/burst) after 6 months' mepolizumab therapy. Becoming OCS free was predicted by a lower body mass index (odds ratio: 0.925; 95% confidence interval: 0.872-0.981), late-onset asthma (1.027; 1.006-1.048), a lower Asthma Control Test score (1.111; 0.011-1.220), and not receiving maintenance OCS therapy at baseline (0.095; 0.040-0.227). Mepolizumab led to a significant and sustained reduction in OCS dependence in patients with severe eosinophilic asthma. This study supports the OCS-sparing effect of mepolizumab and highlights the pivotal role of mepolizumab in OCS stewardship initiatives. Copyright © 2021 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.


Dennis Thomas, Erin S Harvey, Vanessa M McDonald, Sean Stevens, John W Upham, Constance H Katelaris, Vicky Kritikos, Andrew Gillman, John Harrington, Mark Hew, Philip Bardin, Matthew Peters, Paul N Reynolds, David Langton, Melissa Baraket, Jeffrey J Bowden, Simon Bowler, Jimmy Chien, Li Ping Chung, Claude S Farah, Christopher Grainge, Christine Jenkins, Gregory P Katsoulotos, Joy Lee, Naghmeh Radhakrishna, Helen K Reddel, Janet Rimmer, Pathmanathan Sivakumaran, Peter A B Wark, Peter G Gibson. Mepolizumab and Oral Corticosteroid Stewardship: Data from the Australian Mepolizumab Registry. The journal of allergy and clinical immunology. In practice. 2021 Feb 03

PMID: 33545399

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