Long-Term Clinical and Sustained REMIssion in Severe Eosinophilic Asthma treated with Mepolizumab: The REMI-M study
Authors: Crimi Claudia , Nolasco Santi , Noto Alberto , Maglio Angelantonio , Quaranta Vitaliano Nicola , Di Bona Danilo , Scioscia Giulia , Papia Francesco , Caiaffa Maria Filomena , Calabrese Cecilia , D’Amato Maria , Pelaia Corrado , Campisi Raffaele , Vitale Carolina , Ciampo Luigi , Dragonieri Silvano , Minenna Elena , Massaro Federica , Gallotti Lorena , Macchia Luigi , Triggiani Massimo , Scichilone Nicola , Valenti Giuseppe , Pelaia Girolamo , Barbaro Maria Pia Foschino , Carpagnano Giovanna Elisiana , Vatrella Alessandro , Crimi Nunzio 
Published: March 2024

Background

Biological therapies, such as mepolizumab, have transformed the treatment of severe eosinophilic asthma. While 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 REMI-M is a retrospective, real-world, multicenter study that analyzed 303 severe eosinophilic asthma patients 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 corticosteroids (OCS) use, and good asthma control with or without assessment of lung function parameters, were adopted. 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% to 29%. Factors associated with the likelihood of achieving clinical remission included the presence of aspirin-exacerbated respiratory disease, better lung function, male sex, absence of anxiety/depression, gastro-esophageal 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.

HIGHLIGHTS BOX

What is already known about this topic?

Mepolizumab, an anti-IL-5 monoclonal antibody, has been shown to induce clinical remission after 12 months of treatment. However, long-term evidence remains limited.

What does this article add to our knowledge?

The REMI-M study investigated the effectiveness of mepolizumab in achieving clinical and sustained remission over 24 months.

How does this study impact current management guidelines?

Mepolizumab can elicit long-term clinical and sustained remission in a conspicuous proportion of patients with severe eosinophilic asthma, supporting its role as a possible disease-modifying agent. Management of comorbidities and timely identification of patients who may benefit from biological treatment are crucial for optimizing long-term outcomes.