Mepolizumab and oral corticosteroid stewardship - data from Australian Mepolizumab Registry

Abstract Background Oral corticosteroids (OCS) carry serious health risks. Innovative treatment options are required to reduce excessive exposure and promote OCS stewardship. Objectives 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. Methods This real-world observational study included 309 patients from the Australian Mepolizumab Registry who were followed-up for one year (n=225). Results 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 Conclusion 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.