Some patients with eosinophilic asthma are ‘super-responders’ to mepolizumab

SAN ANTONIO — Seventy percent of patients with severe eosinophilic asthma on mepolizumab for 5 to 6 years had no exacerbations for 1 year, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

Ronald A. Strauss

“Our 70% response rate of ‘super-responders’ is based on monthly exams in general while receiving mepolizumab with monthly Asthma Control Questionnaire (ACQ-7) scores to manage these severe asthmatics carefully,” Ronald A. Strauss, MD, director of the Cleveland Allergy and Asthma Center, told Healio.

In a retrospective single-center study, Strauss and his co-authors, Hannah Leflein, RN, MN; Anna Kolesar, RN, MN; and Jeffrey Hammel, MS; analyzed 67 patients (average age, 59 years; range, 21-97; women, n = 37) with severe eosinophilic asthma to determine the real-world efficacy of long-term mepolizumab (Nucala, GSK) treatment. Of the patients, 31 have been receiving mepolizumab for longer than 5 years, and nine have been treated for longer than 6 years.

Before being treated with monthly mepolizumab injections, patients in this study received several different treatments including daily inhaled corticosteroids/long-acting beta-agonists, montelukast and frequent use of an albuterol inhaler. Additionally, patients studied had no less than two bursts of prednisone and/or daily prednisone in the year before commencing mepolizumab treatment, according to researchers.

Researchers assessed patients’ ACQ-7 scores during monthly visits and eosinophil counts before starting mepolizumab and shortly before the study’s conclusion.

Of the total cohort, 47 (70.1%) patients have been classified as “super-responders” — meaning they had no exacerbations requiring oral steroids for 1 year, have experienced a large improvement in asthma control and no longer required daily maintenance steroids. Notably, one “super-responder” patient is 97 years old.

Further, researchers have identified 10 (14.9%) patients as “super-super-responders,” fitting the definition of “super-responders” while only receiving montelukast, and two (3%) patients deemed “super-super-responders-plus” have not received any asthma medication for more than 1 year excluding mepolizumab injections every month, Strauss told Healio.

Compared with the average absolute eosinophil count of 409 cells/µL prior to receiving mepolizumab, patients showed an average current count of 59.7 cells/µL (P < .001).

Patients also demonstrated improvements from baseline in the average ACQ-6 score (1.54 vs. 0.72) and ACQ-7 score (2.09 vs. 1.17; P < .001 for both).

Researchers reported a 2.5% decrease in FEV₁% (74.36% of predicted vs. 72.49% of predicted) and a 30.4% increase in forced expiratory flow (FEF) at 25-75% (52.3% of predicted vs. 68.2% of predicted; P < .001) from baseline.

“The deficiency in the current and admittedly evolving concept of ‘super-responders’ is that, regarding asthma medication, generally authors refer to not being on daily oral corticosteroids or requiring bursts of oral steroids but don’t discuss patients who are no longer on ICS/LABA or long-acting muscarinic antagonists,” Strauss told Healio.

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Ronald A. Strauss, MD, can be reached at straussallergy@yahoo.com.