Potential impact of mepolizumab in stepping down anti-osteporotic treatment in corticosteroid-dependent asthma.

Oral corticosteroids (OCS) are commonly used for the acute management of severe asthma exacerbations or as maintenance therapy; however, chronic use is associated with significant toxicities, e.g., osteoporosis. In the REal worlD Effectiveness and Safety (REDES) study of mepolizumab in a multicentric Spanish cohort of asthma patients, mepolizumab effectively reduced clinically severe asthma exacerbations and decreased OCS dependence. This post-hoc analysis further evaluates mepolizumab's de-escalation effect on OCS dose. Patients enrolled in REDES who had OCS consumption data available for 12 months pre- and post-mepolizumab treatment were included in this analysis. Primary outcomes were to determine the change in the proportion of patients eligible for anti-osteoporotic treatment due to the changes in OCS consumption before and after 1 year of mepolizumab treatment. All analyses are descriptive. Approximately one-third (98/318; 30.8%) of patients in REDES were on maintenance OCS at the time of mepolizumab treatment initiation. In REDES, mean cumulative OCS exposure decreased by 54.3% after 1 year of treatment. The proportion of patients on high-dose OCS (≥7.5 mg/day) fell from 57.1% at baseline to 28.9% after 12 months of mepolizumab treatment. Thus, 53.6% of OCS-dependent asthma patients treated with mepolizumab would cease to be candidates for anti-osteoporotic treatment according to guidelines thresholds.
Competing Interests: CD has received funding for travel or speaker fees from ALK, Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Esteve, Ferrer, GSK, Menarini, Novartis, Stallergenes, and Pfizer. AS has received funding for travel or speaker fees from Chiesi, GSK, Sanofi-aventis, AstraZeneca, Boehringer Ingelheim, ImmunoTek, Menarini, Novartis, Allergy Therapeutics, and Teva. EC has received funding for travel or speaker fees from Lilly, Amgen, UCB, Theramex, STADA, Gedeon-Richter, and GP-Pharm. EM has received speaker or consulting fees from ALK, AstraZeneca, BIAL, Boehringer Ingelheim, Chiesi, GSK, Novartis, Teva, and Sanofi. MB has received speaker or consulting fees from ALK, AstraZeneca, Chiesi, GSK, Novartis, Teva, and Zambón. TC has received speaker fees from ALK, Diater, GSK, LETI, and Novartis. DB is an employee of GSK and holds shares in the company. MS was an employee of GSK when this manuscript was written.
(Copyright © 2023 Domingo, Sogo, Casado, Martínez-Moragón, Blanco-Aparicio, Carrillo, Bañas-Conejero and Sánchez-Herrero.)