title: Mepolizumab  treatment for asthma.
abstract: BACKGROUND
  Five percent of asthmatics have severe symptoms despite high doses of inhaled (ICS) or additional oral corticosteroids (OCS): these patients have high morbidity, risk for asthma death, and account for half of asthma healthcare spending. A subgroup (20 - 40%) of these has persistent airway eosinophilia and frequent exacerbations. Mepolizumab is a humanized monoclonal antibody that blocks binding of the key cytokine implicated specifically in eosinophil maturation and survival, interleukin-5, to its receptor.
  
  
  METHODS
  Pharmacology, Phase I/IIa and Phase II/III studies of mepolizumab for asthma. Mepolizumab depleted blood and sputum eosinophils and partially reduced airway and bone marrow eosinophils. It also reduced airway remodeling. In unselected patients with moderate/severe asthma there was no clinically significant effect on lung function, but a trend to reduced exacerbation rates. When patients were selected for persistent sputum eosinophilia despite high-dose ICS/OCS, and frequent exacerbations, mepolizumab reduced exacerbations by 50%.
  
  
  CONCLUSIONS
  Mepolizumab can reduce exacerbation rates in the severe asthma cohort who have eosinophilic airway inflammation despite corticosteroid treatment. This may be 30% of severe asthmatics and represents a new and important treatment option. Further studies need to confirm efficacy and indications for asthma (and other eosinophilic airway disease), and to examine clinical consequences of reducing remodeling.
authors.affiliation: Imperial College London, Leukocyte Biology, Sir Alexander Fleming Building, London, SW7 2AZ, UK. d.s.robinson@imperial.ac.uk
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Robinson
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000276:immunology / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D015848:Interleukin-5 / Q000276:immunology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D015848:Interleukin-5; C434107:mepolizumab