Long-Term Clinical and Sustained REMIssion in Severe Eosinophilic Asthma Treated With Mepolizumab: The REMI-M Study
Claudia Crimi, Santi Nolasco, Alberto Noto, Angelantonio Maglio, Vitaliano Nicola Quaranta, Danilo Di Bona, Giulia Scioscia, Francesco Papia, Maria Filomena Caiaffa, Cecilia Calabrese, Maria D’Amato, Corrado Pelaia, Raffaele Campisi, Carolina Vitale, Luigi Ciampo, Silvano Dragonieri, Elena Minenna, Federica Massaro, Lorena Gallotti, Luigi Macchia, Massimo Triggiani, Nicola Scichilone, Giuseppe Valenti, Girolamo Pelaia, Maria Pia Foschino Barbaro, Giovanna Elisiana Carpagnano, Alessandro Vatrella, Nunzio Crimi, Rossella Intravaia, Morena Porto, Pietro Impellizzeri, Valentina Frazzetto, Martina Bonsignore, Concetta Giannì, Andrea Alessia Nardo, Fabio Vignera, Maria Teresa Busceti, Nicola Lombardo, Donato Lacedonia, Pasquale Tondo, Piera Soccio, Carla Maria Irene Quarato, Francesca Montagnolo, Vittorio Salerno, Leonardo Maselli, Ernesto Julai, Francesco Coppa, Lucia Grimaldi, Ernesto Julai, Isabella Carrieri, Alessio Sola, Marco Balestrino, Domenica Francesca Mariniello, Isabella Carrieri, Alida Benfante, Giuseppe Spadaro, Aikaterini Detoraki, Luisa Ricciardi, Franzese Antonio, Longobardi Valeria
Abstract
BACKGROUND: Biological therapies, such as mepolizumab, have transformed the treatment of severe eosinophilic asthma. Although mepolizumab's short-term effectiveness is established, there is limited evidence on its ability to achieve long-term clinical remission. OBJECTIVE: To evaluate the long-term effectiveness and safety of mepolizumab, explore its potential to induce clinical and sustained remission, and identify baseline factors associated with the likelihood of achieving remission over 24 months. METHODS: The REMIssion in Severe Eosinophilic Asthma Treated with Mepolizumab (REMI-M) is a retrospective, real-world, multicenter study that analyzed 303 patients with severe eosinophilic asthma who received mepolizumab. Clinical, demographic, and safety data were collected at baseline, 3, 6, 12, and 24 months. The most commonly used definitions of clinical remission, which included no exacerbations, no oral corticosteroid (OCS) use, and good asthma control with or without assessment of lung function parameters, were assessed. Sustained remission was defined as reaching clinical remission at 12 months and maintaining it until the end of the 24-month period. RESULTS: Clinical remission rates ranged from 28.6% to 43.2% after 12 months and from 26.8% to 52.9% after 24 months based on the different remission definitions. The proportion of patients achieving sustained remission varied between 14.6% and 29%. Factors associated with the likelihood of achieving clinical remission included the presence of aspirin-exacerbated respiratory disease, better lung function at baseline, male sex, absence of anxiety/depression, gastroesophageal reflux disease, bronchiectasis, and reduced OCS consumption. Adverse events were infrequent. CONCLUSIONS: This study demonstrates the real-world effectiveness of mepolizumab in achieving clinical remission and sustained remission in severe eosinophilic asthma over 24 months. The identification of distinct factors associated with the likelihood of achieving clinical remission emphasizes the importance of comprehensive management of comorbidities and timely identification of patients who may benefit from biologics.