Adherence to Corticosteroids and Clinical Outcomes in Mepolizumab Therapy for Severe Asthma

Gráinne d'Ancona, Joanne Kavanagh, Cris Roxas, Linda Green, Mariana Fernandes, Louise Thomson, Jaideep Dhariwal, Alexandra M Nanzer, David J Jackson, Brian D Kent
European Respiratory Journal 2020 February 14

INTRODUCTION: Inhaled corticosteroids (ICS) achieve disease control in the majority of asthmatics, although adherence to prescribed ICS is often poor. Patients with severe eosinophilic asthma (SEA) may require treatment with oral corticosteroids (OCS) and/or biologic agents such as mepolizumab. It is unknown if ICS adherence changes on, or alters clinical response to, biologic therapy.

METHODS: We examined ICS adherence and clinical outcomes in OCS-dependent SEA patients who completed 1 year of mepolizumab therapy. The ICS Medicines Possession Ratio was calculated (MPR; the number of doses of ICS issued on prescription/expected number) for the year before and the year after biologic initiation. Good adherence was defined as MPR>0.75, intermediate: 0.74-0.51 and poor: <0.5. We examined outcomes after 12 months of biologic therapy, including OCS reduction and annualised exacerbation rate (AER), stratified by adherence to ICS on mepolizumab.

RESULTS: Of 109 patients commencing mepolizumab, 91 who had completed 12 months of treatment were included in the final analysis. Whilst receiving mepolizumab, 68% had good ICS adherence, with 16(18%) having poor ICS adherence. ICS use within the cohort remained similar before (MPR 0.81±0.32) and on mepolizumab (0.82±0.32;p=0.78). Patients with good adherence had greater reductions in OCS dose (median percentage OCS reduction 100(IQR 74-100) versus 60(IQR 27-100);p=0.031) and exacerbations (AER change -2.1±3.1 versus 0.3±2.5;p=0.011) than those with poor adherence. Good ICS adherence predicted the likelihood of stopping maintenance OCS (adjusted OR 3.19;95%CI 1.02-9.94;p=0.045).

CONCLUSION: ICS non-adherence is common in SEA patients receiving mepolizumab, and is associated with a lesser reduction in OCS requirements and AER.


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