What is it about?
Mepolizumab is a treatment that lowers the number of a type of white blood cell called eosinophils. Eosinophils can cause inflammation and lead to asthma symptoms in patients with severe eosinophilic asthma. Mepolizumab helps to control asthma symptoms, such as asthma flares (also called exacerbations), for patients with severe eosinophilic asthma. We looked at how well mepolizumab worked in patients with severe eosinophilic asthma who had received mepolizumab regularly for at least three years. Patients were randomly chosen to either stop or continue taking mepolizumab and were not told which group they were in (a blinded study). They were then followed for at least one year to see if their asthma symptoms changed. We found that patients who stopped taking mepolizumab had a higher risk of having an asthma flare compared with patients who continued treatment. They also had worse asthma symptoms and lower quality of life. Patients who stopped taking mepolizumab had higher numbers of eosinophils in their blood. As seen before, mepolizumab had few side effects.
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Why is it important?
This study is the first to explore the effect of stopping mepolizumab treatment after long-term use in patients with severe eosinophilic asthma. It showed that the benefits of mepolizumab are not likely to be maintained if treatment is stopped. Long-term use of mepolizumab may be needed to manage symptoms.
Perspectives
Finding out if a patient with severe eosinophilic asthma should keep taking mepolizumab matters, because it makes sure that patients only get the treatment that they need. We found that, for most patients, continuing mepolizumab is more likely to keep controlling their asthma symptoms compared with stopping treatment. This was especially true for patients who had no exacerbations on mepolizumab. These “super-responders” are the most likely patients in clinic to be considered for discontinuation of therapy, but they are at an increased risk of having an exacerbation after stopping the drug in the COMET study.
Wendy Moore
Wake Forest School of Medicine
Read the Original
This page is a summary of: Stopping versus continuing long-term mepolizumab treatment in severe eosinophilic asthma (COMET study), European Respiratory Journal, June 2021, European Respiratory Society (ERS),
DOI: 10.1183/13993003.00396-2021.
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