Effect of mepolizumab in airway remodeling in patients with late-onset severe asthma with an eosinophilic phenotype

作者：Kalliopi Domvri, Ioanna Tsiouprou, Petros Bakakos, Paschalis Steiropoulos, Κonstantinos Κatsoulis, Κonstantinos Κostikas, Κατερίνα Αντωνίου, Andriana Ι. Papaioannou, Νikoletta Ρovina, Paraskevi Κatsaounou, Theodora Papamitsou, Nicoleta Pastelli, Stavros Τryfon, Evangelia Fouka, Despoina Papakosta, Stelios Loukides, Κonstantinos Porpodis · 发表于：Journal of Allergy and Clinical Immunology · 年份：2024 · DOI：10.1016/j.jaci.2024.10.024 · 被引用次数：54 · 研究领域：Asthma and respiratory diseases、Delphi Technique in Research、Chronic Obstructive Pulmonary Disease (COPD) Research

BACKGROUND: Clinical trials and real-world experience have provided evidence for the clinical benefits of mepolizumab, an anti-IL-5 biologic, in severe asthma. However, limited data exist regarding the impact of mepolizumab on airway remodeling. OBJECTIVE: We sought to investigate the effect of mepolizumab on airway structural remodeling in patients treated for severe asthma in routine clinical care. METHODS: The MESILICO (Efficacy of Mepolizumab in patients with latE-onset Severe eosInophiLic asthma and fIxed obstruCtiOn) study is a multicenter study involving 8 pulmonology departments in Greece. This study focused on patients who initiated mepolizumab for severe asthma with an eosinophilic phenotype and had late-onset disease with obstructive patterns (impaired reversibility). Forty-seven patients were recruited, of whom 41 were enrolled in the bronchoscopy substudy. The findings were related to clinical outcome. RESULTS: After 12 months, mepolizumab treatment was associated with significant improvements in lung function and Asthma Control Test score, along with a significant decrease in severe exacerbation events (P < .001). Thirty-four of the 41 participants (83%) had paired biopsies for comparative analysis. There was a significant reduction from baseline in sub-basement membrane thickness, airway smooth muscle area, airway smooth muscle layer thickness, extent of epithelial damage, and number of tissue eosinophils (all P < .001). The extent of reduction in airway smooth...