Clinical Remission is Achievable for Adult Patients with Severe Asthma Receiving Mepolizumab: A European Retrospective Chart Review

Abstract

The introduction of precision therapy in severe asthma is shifting treatment goals from asthma control towards the more ambitious target of clinical remission. This study evaluated clinical remission in patients with severe asthma receiving mepolizumab in Europe. A retrospective, physician panel-based chart review was conducted based on anonymised data from patients who initiated mepolizumab in Italy, Germany, and France from 30 June 2017 to 30 June 2022. Primary outcome was clinical remission at Year 1 post-initiation, defined as the absence of severe or clinically significant asthma exacerbations, no maintenance oral corticosteroid use in Month 12, and an Asthma Control Test score ≥ 20, plus either lung function stabilisation (no worsening of forced expiratory volume in 1 s [FEV1] from baseline) or lung function optimisation (FEV1 ≥ 80% predicted). Individual components of clinical remission were compared before versus after mepolizumab initiation, and clinical remission at Year 2 was also assessed. Data from 308 patients were included by 117 physicians. Clinical remission based on lung function stabilisation was achieved by 37.8% of patients (101/267) at Year 1 and 58.7% (108/184) at Year 2. Remission based on lung function optimisation was achieved by 18.8% (58/308) at Year 1 and 28.6% (55/192) at Year 2. Regardless of the lung function definition used, ≥ 90% of patients who achieved remission at Year 1 maintained it until Year 2 (among those with evaluable data). Individual components of clinical remission, including FEV1 ≥ 80% predicted, showed significant improvements at 12 months compared with baseline (all p < 0.001). This real-world study demonstrates that clinical remission is an ambitious and achievable treatment goal for patients with severe asthma treated with mepolizumab in Europe. Graphical abstract available for this article. Mepolizumab is an injectable treatment for severe asthma. As effective treatments like mepolizumab are developed for severe asthma, some patients reach a point where they have no severe asthma attacks, do not need to use steroid-based tablets, have their asthma under control, and have either stable lung function (i.e. lung function did not get worse) or optimal lung function (i.e. lung function reaches the level of a healthy adult) for at least 1 year. This is referred to as being in "clinical remission". The goal of this study was to determine whether patients treated with mepolizumab could achieve clinical remission. Doctors reviewed the medical records of 308 patients treated with mepolizumab in Europe (France, Germany, and Italy) from 2017 to 2022. Using lung function stabilisation as the measure, 38% of patients achieved clinical remission after 1 year, increasing to 59% after 2 years. Using lung function optimisation as the measure, 19% of patients achieved remission after 1 year, rising to 29% by the 2nd year. Most patients who achieved remission in the 1st year also achieved remission in the 2nd year, regardless of the definition used. This study showed that clinical remission is an ambitious and achievable goal for many people with severe asthma treated with mepolizumab.