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https://ahro.austin.org.au/austinjspui/handle/1/25782| Title: | Mepolizumab and oral corticosteroid stewardship - data from Australian Mepolizumab Registry. | Austin Authors: | Thomas, Dennis;Harvey, Erin S;McDonald, Vanessa M;Stevens, Sean ;Upham, John W;Katelaris, Constance H;Kritikos, Vicky;Gillman, Andrew;Harrington, John;Hew, Mark;Bardin, Philip;Peters, Matthew;Reynolds, Paul N;Langton, David;Baraket, Melissa;Bowden, Jeffrey J;Bowler, Simon;Chien, Jimmy;Chung, Li Ping;Farah, Claude S;Grainge, Christopher;Jenkins, Christine;Katsoulotos, Gregory P;Lee, Joy ;Radhakrishna, Naghmeh;Reddel, Helen K;Rimmer, Janet;Sivakumaran, Pathmanathan;Wark, Peter A B;Gibson, Peter G | Affiliation: | Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Newcastle, Australia Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia Priority Research Centre for Healthy Lungs, Faculty of Health, University of Newcastle, Newcastle, Australia Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Australia Faculty of Medicine, The University of Queensland, Brisbane, Australia School of Medicine, Western Sydney University, Campbelltown, Australia Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, Australia Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Australia School of Public health and Preventive Medicine, Monash University, Melbourne, Australia Lung and Sleep Medicine, Monash University and Medical Centre and Hudson Institute, Clayton, Australia Department of Thoracic Medicine, Concord Hospital, Concord, Australia Lung Research, University of Adelaide and Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia Dept of Thoracic Medicine, Frankston Hospital, Frankston, Australia South Western Sydney Clinical School, University of New South Wales, Sydney, Australia Ingham Institute for Applied Medical Research, Sydney, Australia Respiratory and Sleep Services, Flinders Medical Centre and Flinders University, Bedford Park, Australia Department of Respiratory Medicine, Mater Hospital, Brisbane, Australia Department of Sleep and Respiratory Medicine, Westmead Hospital, Westmead, Australia School of Medicine, The University of Sydney, Sydney, Australia Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Australia Department of Thoracic Medicine, Concord Hospital, Concord, Australia Concord Clinical School, University of Sydney, Concord, Australia St George Specialist Centre, Kogarah, Australia St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia Austin Health Respiratory Department, St Vincent's Hospital, Melbourne, Australia Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia St Vincent's Clinic, Darlinghurst, Australia Department of Respiratory Medicine, Gold Coast University Hospital, Gold Coast, Australia |
Issue Date: | 2-Feb-2021 | Date: | 2021-02-02 | Publication information: | The Journal of Allergy and Clinical Immunology. In Practice 2021; online first: 2 February | Abstract: | 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 severe eosinophilic asthma patients 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 one year (n=225). Patients had a median age of 60 (IQR 50,68) years, and 58% were female. At baseline, 48% used maintenance OCS, 96% had ≥1 OCS burst and 68% had received ≥1gram 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<0.001). Likewise, proportions of patients receiving OCS bursts in the previous year reduced from 96% at baseline to 50% at 12-months (p<0.001). Overall, 137 (48%) patients required OCS (maintenance/burst) after 6-months' mepolizumab therapy. Becoming OCS free was predicted by a lower body mass index (OR 0.925; 95%CI 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. | URI: | https://ahro.austin.org.au/austinjspui/handle/1/25782 | DOI: | 10.1016/j.jaip.2021.01.028 | Journal: | The Journal of Allergy and Clinical Immunology. In Practice | PubMed URL: | 33545399 | Type: | Journal Article | Subjects: | OCS stewardship Oral corticosteroid mepolizumab observational study severe eosinophilic asthma |
| Appears in Collections: | Journal articles |
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