Sustained clinical remission and relapse of severe eosinophilic asthma following long-term mepolizumab treatment

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BACKGROUND: While clinical remission occurs in some patients receiving biologics for severe asthma after one year of treatment, sustaining remission and frequency of relapse are unclear. This study evaluated sustained clinical remission, relapse, and its predictors over two to four years among people with severe asthma receiving mepolizumab. METHODS: Data from 208 patients (median age 59.6 years [52.0, 68.9], 41.3% male) in the Australian Mepolizumab Registry, a real-world prospective severe asthma registry, were analysed. Clinical remission was defined as: mean Asthma Control Questionnaire-5 score ≤1.0, no exacerbations, and no oral corticosteroid use over a 12-month period. Remission and relapse were assessed from 12 to 48 months at 12-month intervals. RESULTS: Of 184 with data available at 24 months, 29.9% (n = 55) achieved remission. 20.1% (35 of 174 with data from baseline to 24 months) sustained remission showing certain degree of stability since treatment initiation, while 9.2% (16/174) relapsed during treatment. Older age, severe disease, obesity, and depression significantly reduced the odds of achieving remission at 24 months. When assessed longitudinally (n = 47 with data from baseline to 48 months), remission increased from 36.1% at 12 months to 48.9% at 48 months. However, 17% relapsed over four years. Patterns of persistent non-remission, stable, delayed and unstable remission were also observed. CONCLUSIONS: Although remission rates may be overestimated in a cohort skewed toward treatment-responsive patients, clinical remission is achievable and sustained in a subgroup of patients with asthma, while remaining transient in some patients who risk relapsing and transitioning between disease states during continued mepolizumab treatment.

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