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Adherence to inhaled 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 55: 1902259; DOI: 10.1183/13993003.02259-2019
Gráinne d'Ancona
1Guy's Severe Asthma Centre, Guy's and St Thomas’ Hospitals, London, UK
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Joanne Kavanagh
1Guy's Severe Asthma Centre, Guy's and St Thomas’ Hospitals, London, UK
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Cris Roxas
1Guy's Severe Asthma Centre, Guy's and St Thomas’ Hospitals, London, UK
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Linda Green
1Guy's Severe Asthma Centre, Guy's and St Thomas’ Hospitals, London, UK
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Mariana Fernandes
1Guy's Severe Asthma Centre, Guy's and St Thomas’ Hospitals, London, UK
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Louise Thomson
1Guy's Severe Asthma Centre, Guy's and St Thomas’ Hospitals, London, UK
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Jaideep Dhariwal
1Guy's Severe Asthma Centre, Guy's and St Thomas’ Hospitals, London, UK
2Asthma UK Centre, King's College London, London, UK
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Alexandra M. Nanzer
1Guy's Severe Asthma Centre, Guy's and St Thomas’ Hospitals, London, UK
2Asthma UK Centre, King's College London, London, UK
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David J. Jackson
1Guy's Severe Asthma Centre, Guy's and St Thomas’ Hospitals, London, UK
2Asthma UK Centre, King's College London, London, UK
4Both authors contributed equally
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  • ORCID record for David J. Jackson
Brian D. Kent
1Guy's Severe Asthma Centre, Guy's and St Thomas’ Hospitals, London, UK
2Asthma UK Centre, King's College London, London, UK
3Dept of Respiratory Medicine, St James’ Hospital, Dublin, Ireland
4Both authors contributed equally
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  • For correspondence: briankent@physicians.ie
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Abstract

Introduction Inhaled corticosteroids (ICS) achieve disease control in the majority of asthmatic patients, although adherence to prescribed ICS is often poor. Patients with severe eosinophilic asthma 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 severe eosinophilic asthma patients who completed 1 year of mepolizumab therapy. The ICS medicines possession ratio (MPR) was calculated (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 Out of 109 patients commencing mepolizumab, 91 who had completed 12 months of treatment were included in the final analysis. While 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 during mepolizumab treatment (0.82±0.32; p=0.78). Patients with good adherence had greater reductions in OCS dose (median (interquartile range) OCS reduction 100 (74–100)% versus 60 (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 nonadherence is common in severe eosinophilic asthma patients receiving mepolizumab, and is associated with a lesser reduction in OCS requirements and AER.

Abstract

Poor adherence to ICS is common in severe asthma patients receiving mepolizumab, and is associated with increased oral corticosteroid exposure and exacerbation risk http://bit.ly/2v9hdAi

Footnotes

  • This article has an editorial commentary: https://doi.org/10.1183/13993003.00954-2020

  • Conflict of interest: G. d'Ancona reports personal fees from GSK, during the conduct of the study; grants and personal fees from AstraZeneca, personal fees from Napp Pharmaceuticals, Chiesi Pharmaceuticals, Boehringer Ingelheim and Teva Pharmaceuticals, outside the submitted work.

  • Conflict of interest: J. Kavanagh has nothing to disclose.

  • Conflict of interest: C. Roxas has nothing to disclose.

  • Conflict of interest: L. Green has nothing to disclose.

  • Conflict of interest: M. Fernandes has nothing to disclose.

  • Conflict of interest: L. Thomson has nothing to disclose.

  • Conflict of interest: J. Dhariwal has nothing to disclose.

  • Conflict of interest: A.M. Nanzer has nothing to disclose.

  • Conflict of interest: D.J. Jackson reports grants and personal fees from AstraZeneca, outside the submitted work.

  • Conflict of interest: B.D. Kent reports personal fees from GSK, during the conduct of the study; personal fees from AstraZeneca, Napp Pharmaceuticals and Chiesi Pharmaceuticals, non-financial support from Boehringer Ingelheim and Teva Pharmaceuticals, outside the submitted work.

  • Received November 22, 2019.
  • Accepted February 3, 2020.
  • Copyright ©ERS 2020
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Adherence to inhaled 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 May 2020, 55 (5) 1902259; DOI: 10.1183/13993003.02259-2019

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Adherence to inhaled 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 May 2020, 55 (5) 1902259; DOI: 10.1183/13993003.02259-2019
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