ABSTRACT
IntroductionReal-world data on Omalizumab (OMA) and Mepolizumab (MEPO) can inform
their use in severe asthma (SA). We studied patients in the Wessex
AsThma CoHort of difficult asthma (WATCH) to: 1. Phenotypically compare
OMA or MEPO treated patients against a SA, non-biologic group (SNB). 2.
Assess clinical responses to OMA and MEPO. 3. Assess the spectrum of
responses to these biologics.
MethodsWe retrospectively phenotyped biologic naïve patients from WATCH (N=478)
commenced on OMA (N=105) or MEPO (N=62) compared to SNB (N=178).
Biologic response was gauged using standard criteria and response
features were identified using logistic regression.
ResultsOMA and MEPO patients were phenotypically distinct. Both drugs
significantly reduced exacerbations, acute healthcare encounters
(emergency department or hospital admissions), maintenance oral
corticosteroid dose, and improved Asthma Control Questionnaire 6 (ACQ6)
scores. OMA patients with more exacerbations at baseline (P=0.024), less
acute healthcare encounters (P=0.050), and no anxiety (P=0.008) were
more likely to respond to it. Lower baseline ACQ6 was independently
associated with higher odds of MEPO response (P=0.007). Combined (OMA or
MEPO) non-responders had significantly more psychological co-morbidities
and worse baseline subjective disease markers compared to responder
groups. Current criteria used to measure trial outcomes for MEPO, but
not OMA, missed some modalities of response.