Mepolizumab in Patients With Severe Asthma and Comorbidities: 1-Year REALITI-A Analysis

Background Severe asthma is complex; comorbidities may influence disease outcomes. Objective To assess mepolizumab effectiveness in patients with severe asthma and comorbidities. Methods REALITI-A was a 2-year international, prospective study enrolling adults with asthma newly prescribed mepolizumab (100 mg subcutaneously) at physician's discretion. This post hoc analysis assessed 1-year outcomes stratified by comorbidities at enrollment: chronic rhinosinusitis with nasal polyps (CRSwNP), gastro-esophageal reflux disease (GERD), depression/anxiety and chronic obstructive pulmonary disease (COPD). Outcomes included the rate of clinically significant asthma exacerbations (CSEs; requiring systemic corticosteroids and/or hospital/emergency room admission) between the 12 months pre- and post-mepolizumab treatment and changes from baseline in daily maintenance oral corticosteroid (mOCS) dose (Month 12), Asthma Control Questionnaire (ACQ)-5 score (Month 12) and forced expiratory volume in 1 second (FEV1; Months 9–12). Results At enrollment (N=822), 321/822 (39%), 309/801 (39%), 203/785 (26%) and 81/808 (10%) patients had comorbid CRSwNP, GERD, depression/anxiety, and COPD, respectively. Post- versus pre-treatment across all comorbidity subgroups: the rate of CSEs decreased by ≥63%; among 298 (39%) patients on mOCS at baseline, median dose decreased by ≥50%; ACQ-5 score decreased by ≥0.63 points; FEV 1 increased by ≥74 mL. Patients with versus without CRSwNP had the greatest improvements (e.g. rate of CSEs decreased by 75%). Patients without GERD, depression/anxiety or COPD had greater improvements than those with the respective comorbidities, except for FEV 1 in patients with COPD. Conclusion Mepolizumab improved disease outcomes in patients with severe asthma irrespective of comorbidities, with additional benefit for patients with CRSwNP.