Would you recognise severe refractory eosinophilic asthma?
Severe asthma is a heterogeneous disease comprised of different phenotypes with specific clinical and pathophysiological features.2–5 ‘Severe eosinophilic’ asthma refers to a type of asthma that is both severe and has an eosinophilic phenotype. 1,6,7
Before diagnosing patients with ‘severe’ asthma, physicians should ensure the patient is adhering to their current asthma medications, and that co-morbid conditions have been ruled out. 2
Do you recognise these patients in your practice?
Diagnosed with asthma: 7 years ago
- High-dose maintenance fluticasone propionate / salmeterol (500/50mcg)
- Two exacerbations requiring OCS treatment last year
FEV1 percentage predicted: 62%
Blood eosinophil count: 400 cells/μL
Serum IgE: 150U/mL
Diagnosed with asthma: 15 years ago
- High-dose maintenance fluticasone furoate/vilanterol (184/22mcg)
- Maintenance OCS (prednisone 15mg/day)
- Four exacerbations in the last year
FEV1 percentage predicted: 58%
Blood eosinophil count: 300 cells/μL
Serum IgE: 117U/mL
Identify patients, who most likely will benefit from treatment with Nucala, based on the following criteria:
- Severe, uncontrolled asthma despite high-level therapy1
High dose of inhaled corticosteroids (ICS) and other controller medication(s)
Two or more exacerbations in the previous 12 months and/or dependency on systemic corticosteroids
≥150 cells/µL at initiation of treatment
≥300 cells/µL in the prior 12 months (determined through a routine blood test)
Nucala is indicated as an add-on treatment for adults, adolescents and children ≥ 6 years with severe refractory eosinophilic asthma.1
The recommended dose of mepolizumab for adults and adolescents ≥12 years is 100 mg administered subcutaneously once every 4 weeks. The recommended dose of mepolizumab for children aged 6 to 11 years old is 40 mg administered subcutaneously once every 4 weeks. Nucala is intended for long-term treatment. The need for continued therapy should be considered at least on an annual basis as determined by physician assessment of the patient’s disease severity and level of control of exacerbations.1
* This is fictional case study for illustrational purposes only.
- Nucala preparatomtale
- Chung KF, Wenzel SE, Brozek JL et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014; 43:343–373
- Campo P, Rodriguez F, Sánchez-Garcia S et al. Phenotypes and endotypes of uncontrolled severe asthma: new treatments. J Investig Allergol Clin Immunol 2013; 23:76–88.
- Garcia G, Taillé C, Laveneciana P et al. Anti-interleukin-5 therapy in severe asthma. Eur Respir Rev 2013; 22:251–257.
- Corren J. Asthma phenotypes and endotypes: an evolving paradigm for classification. Discov Med 2013; 15:243–-249.
- Pavord ID, Korn S, Howarth P et al. Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial. Lancet 2012; 380:651–659.
- Ortega H, CChupp G, Bardin P et al. The role of mepolizumab in atopic and nonatopic severe asthma with persistent eosinophilia. Eur Respir J 2014; 44:239–241.
- Ortega HG, Yancey SW, Mayer B et al. Severe eosinophilic asthma treated with mepolizumab stratified by baseline eosinophil thresholds: a secondary analysis of the DREAM and MENSA studies. Lancet Respir Med 2016; 4:549–556.