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Effectiveness of Mepolizumab in Patients with OCS-Dependent Severe Asthma: A Real-World Study

Year: 2025

Type: article

Abstract: Before the availability of biologic therapies, the main treatment for patients with severe asthma in Asia, Latin America, and the Middle East was oral corticosteroids (OCS), despite long-term use causing serious adverse effects. This post hoc analysis of the NUCALA Effectiveness Study (NEST) evaluated the effectiveness of mepolizumab, an anti-interleukin-5 monoclonal antibody, in patients with severe asthma and OCS dependence from regions with limited representation in real-world studies. NEST was a multicountry, observational cohort study in adults with severe asthma from Colombia, Chile, India, Türkiye, Saudi Arabia, United Arab Emirates, Kuwait, Oman, and Qatar. Patients received ≥ 1 dose of 100 mg mepolizumab. OCS dependence was defined as receiving maintenance OCS at mepolizumab initiation or for ≥ 26 weeks during the 12 months prior. Data were collected 12 months pre- and post-initiation. Outcomes included OCS use, rate of clinically significant exacerbations (CSEs), and level of asthma symptom control. Of 524 patients with OCS use data, 58.4% (n = 306) had OCS dependence pre-initiation. Mean (standard deviation) age was 49.2 (13.4) years; 73.9% (n = 226) were women. Of 251 patients with available data, 87.6% (n = 220) received lower OCS doses post-initiation and 68.9% (n = 173) stopped OCS use altogether. CSEs were reduced by 76.9% post-initiation. Of 222 patients with available data, 72.5% (n = 161) had improvements in Asthma Control Test scores post-initiation. In patients with severe asthma and OCS dependence from the countries studied, mepolizumab reduced OCS use and dose, asthma exacerbations, and improved symptom control. Severe asthma is a long-term disorder of the lungs. Symptoms can be difficult to control, despite treatment. Asthma treatment can differ depending on the healthcare services and treatments available, with some countries having more extensive research and access to asthma medications than others. People with severe asthma often receive high doses of oral corticosteroids (OCSs) over prolonged time periods which can cause side effects and affect quality of life. Mepolizumab is a medication used to treat severe asthma. Studies show that mepolizumab treatment can reduce the use of OCS, as well as the risk of major asthma attacks, and improve control of symptoms. The NUCALA Effectiveness Study was carried out to see how well mepolizumab works in real-life clinical practice for treatment of severe asthma in patients living in Colombia, Chile, India, Türkiye, Saudi Arabia, United Arab Emirates, Kuwait, Oman, and Qatar. Here, we looked at how effective mepolizumab was at reducing OCS use for people who required OCS consistently before they started taking mepolizumab (OCS dependence). We found that fewer people relied on OCS following mepolizumab treatment, with nearly 90% receiving a lower dose following treatment with mepolizumab. Almost 70% of these people had their dose reduced entirely so they no longer needed OCS. Additionally, mepolizumab treatment significantly reduced the number of major asthma attacks people experienced and led to better asthma symptom management. These results suggest that mepolizumab could be beneficial for people with severe asthma, in regions where asthma symptoms and the use of OCS are high.

Source: Advances in Therapy

DOI: 10.1007/s12325-025-03338-w