Real-World Effectiveness of Mepolizumab in Severe Asthma: Results from the Multi-country, Self-controlled Nucala Effectiveness Study (NEST)

• DOI: 10.1007/s12325-024-02967-x
• Publication Date: 2024-08-31T06:02:01Z
• Authors: Riyad Omar Al-Lehebi; Mona Al Ahmad; Venkata Nagarjuna...; Alejandra Galeano...; Bassam Mahboub; Elizabeth Garcia; Patricia Fernandez; Claudia Soares; Gabriela Abreu; Debora dos Santos; Juliana Queiroz; Alejandro Raimondi; Maria Laucho-Cont...; Saeed Noibi; Gur Levy; Sevim Bavbek
• Keywords: Clinical endpoint; Rate ratio

The Nucala Effectiveness Study (NEST) assessed the effectiveness of mepolizumab in patients with severe asthma (SA) countries previously underrepresented real-world studies. A multi-country, bi-directional, self-controlled, observational cohort study conducted Colombia, Chile, India, Türkiye, Saudi Arabia, United Arab Emirates, Kuwait, Oman, and Qatar. Historical and/or prospective data from SA were 12 months pre- post-mepolizumab initiation. Primary endpoint: incident rate ratio (IRR) clinically significant exacerbations (CSEs). Key secondary endpoints: healthcare resource utilisation (HCRU), oral corticosteroid (OCS) use, lung function symptom control (Asthma Control Test [ACT] scores). Overall, 525 burden pre-initiation (geometric mean blood eosinophil count [BEC] 490.7 cells/µl; 31.4% prior biologic use; 37.3% obese) received at least one dose 100 mg subcutaneously. Post-initiation, a reduction CSEs was observed (76% [p < 0.001]; IRR [95% confidence interval] 0.24 [0.19–0.30]); 72.0% had no CSEs. Mepolizumab treatment led to OCS use (52.8% vs. 16.6% post-initiation) (standard deviation [SD]) change − 18.1 (20.7) post-initiation; 36.1% became OCS-free. Fewer hospitalised post-initiation (22.5% 6.9% post-initiation). Improvements (SD) forced expiratory volume 1 s (62.8 [20.2]% 73.0 [22.7]% ACT scores (15.0% 64.5% well-controlled asthma) observed. Proportion BEC ≥ 500 cells/µl decreased 84.4% 18.1% post-initiation. effective reducing by significantly CSEs, HCRU, improving control, which could translate improvements health-related quality life high dependency studied. graphical abstract is available this article. Severe occurs when symptoms remain uncontrolled despite optimised treatment. In many low-middle income countries, some Middle East, Asia, Latin America Gulf, management poor, having unscheduled hospital visits or admission, steroids for prolonged period. an injectable monoclonal antibody approved as add-on 6 years age. clinical trials, has demonstrated reductions risk (CSE; exacerbation that requires systemic corticosteroids emergency room visit hospitalisation) need inflammation caused (a type white cell) production. performed observe people Turkey, Oman frequency other outcomes compared reduced 76% (p 0.001), 72% dependent on OCS, not using all, fewer hospitalised. Lung also improved. NEST shows benefit living where disease-related high.