Mepolizumab treatment and reduced oral corticosteroid exposure improves symptoms of depression and anxiety in severe eosinophilic asthma: data from the Australian Mepolizumab Registry

Background: The benefits of oral corticosteroid (OCS) stewardship approaches -including monoclonal antibody treatments for severe asthma- on reducing toxic OCS exposure and related comorbidities such as depression and anxiety require real-world evaluation. Methods: This real-world observational study investigated OCS exposure and associated complications over 24 months in patients enrolled in the Australian Mepolizumab Registry (n = 412). Results: Patients were median age 59 years, 58 % were female. The proportion of patients receiving OCS burst in the year prior to commencement was 95 % (44 % during second year of treatment, p < 0.001). In the year prior to baseline, 64 % received toxic level OCS exposure (≥1000 mg), with more disease burden and doctor diagnosed depression (27 % v 15 %, p = 0.020). Ongoing toxic level exposure was reduced to 25 % of patients in the second year of mepolizumab treatment (p < 0.001). At baseline, 42 % required maintenance OCS which reduced to 18 % after two years of treatment (p < 0.001). Hospital Anxiety and Depression Scale (HADS)-Depression score ≥8 was evident in 37 % of patients at baseline and reduced to 15 % after two years (p < 0.001). HADS-Anxiety score ≥8 was reduced from 44 % of patients to 25 % after two years (p < 0.001). Improvements in HADS scores correlated with improvement in Asthma Quality of Life Questionnaire score. Conclusion: Mepolizumab treatment reduces exposure to toxic levels of OCS in severe eosinophilic asthma, with reduction in associated complications, confirming the importance of OCS stewardship initiatives. Improvements in both asthma outcomes, and clinically relevant treatable traits including depression and anxiety, further highlights the role of biologics within the OCS stewardship framework.