Mepolizumab reduces exacerbations in patients with severe eosinophilic asthma, irrespective of body weight/body mass index: meta-analysis of MENSA and MUSCA

Abstract

BackgroundWe assessed the efficacy of the licensed mepolizumab dose (100\u2009mg subcutaneously [SC]) in patients with severe eosinophilic asthma according to body weight/body mass index (BMI).MethodsThis was a post hoc individual patient-level meta-analysis of data from the Phase 3 studies MENSA (MEA115588/NCT01691521) and MUSCA (200862/NCT02281318). Patients aged ≥12\u2009years with severe eosinophilic asthma and a history of exacerbations were randomised to 4-weekly placebo, mepolizumab 75\u2009mg intravenously (IV) or 100\u2009mg SC (MENSA) or placebo or mepolizumab 100\u2009mg SC (MUSCA) for 32 (MENSA) or 24 (MUSCA) weeks. The primary endpoint was the annual rate of clinically significant exacerbations; other outcomes included the proportion of patients with no exacerbations, lung function, St George’s Respiratory Questionnaire (SGRQ) and Asthma Control Questionnaire-5 (ACQ-5) scores and blood eosinophil counts. Analyses were performed by baseline body weight and BMI (≤60, >\u200960–75, >\u200975–90, >\u200990, <\u2009100, ≥100\u2009kg; ≤25, >\u200925–30, >\u200930, <\u200936, ≥36\u2009kg/m2).ResultsOverall, 936 patients received placebo or mepolizumab 100\u2009mg SC. Across all body weight/BMI categories, mepolizumab reduced the rate of clinically significant exacerbations by 49–70% versus placebo. Improvements with mepolizumab versus placebo were also seen in lung function in all body weight/BMI categories except >\u200990\u2009kg; improvements in SGRQ and ACQ-5 scores were seen across all categories.ConclusionsMepolizumab 100\u2009mg SC has consistent clinical benefits in patients with severe eosinophilic asthma across a range of body weights and BMIs. Data show that the fixed-dose regimen of mepolizumab is suitable, without the need for weight-based dosing.Trial registrationThis manuscript is a post hoc meta-analysis of data from the Phase 3 studies MENSA and MUSCA. ClinicalTrials.gov, NCT01691521 (MEA115588; MENSA). Registered September 24, 2012. ClinicalTrials.gov, NCT02281318 (200862; MUSCA). Registered November 3, 2014.