Mepolizumab real-world effectiveness in severe asthma with an eosinophilic phenotype and overlapping severe allergic asthma
Bibliographic record
Abstract
BACKGROUND: Some patients with severe asthma have overlapping allergic and eosinophilic phenotypes and may be eligible for anti-eosinophilic or anti-immunoglobin E (IgE) biologics. OBJECTIVE: This post hoc sub-analysis assessed real-world mepolizumab effectiveness in patients with overlapping allergic and eosinophilic phenotypes, using 1-year data from the international, prospective REALITI-A (REAL world effectiveness of mepolizumab In paTIent care - Asthma) study. METHODS: The clinically significant asthma exacerbations (CSE) rate was assessed 1 year before (pretreatment) and after (follow-up) mepolizumab treatment, stratified by baseline total IgE (tIgE) levels (<60, 60 to <190, 190 to <550, and ≥550 kilounits per litre [kU/L]), atopic status (yes/no/unknown), previous omalizumab use (yes/no), geographic baseline omalizumab eligibility (eligible/non-eligible), and baseline tIgE level and blood eosinophil count threshold combinations (<81 or ≥81 kU/L and <300 or ≥300 cells per microliter [cells/μL]). RESULTS: Overall, 822 patients were included. CSEs occurred in 760 patients (93%) pretreatment and 398 patients (49%) during follow-up. CSE rate (rate ratio [95% CI]) was reduced in follow-up across all tIgE subgroups (<60 [n = 173]: 0.31 [0.25-0.37]; 60 to <190 [n = 176]: 0.30 [0.25-0.36]; 190 to <550 [n = 170]: 0.26 [0.20-0.33]; ≥550 kU/L [n = 155]: 0.28 [0.23-0.35]) and irrespective of atopic status (yes [n = 422]: 0.29 [0.26-0.33]; no [n = 52]: 0.33 [0.23-0.47]; unknown [n = 348]: 0.28 [0.24-0.32]), previous omalizumab use (yes [n = 151]: 0.37 [0.30-0.45]; no [n = 671]: 0.27 [0.24-0.30]), or eligibility (eligible [n = 349]: 0.29 [0.25-0.34]; non-eligible [n = 191]: 0.32 [0.27-0.38]). Furthermore, the CSE rate was reduced across all tIgE (kU/L) and blood eosinophil count (cells/μL) combinations (<81/<300 [n = 53]: 0.34 [0.24-0.47]; <81/≥300 [n = 103]: 0.33 [0.26-0.41]; ≥81/<300 [n = 98]: 0.36 [0.28-0.47]; ≥81/≥300 [n = 249]: 0.26 [0.22-0.31]). CONCLUSION: Mepolizumab demonstrates real-world effectiveness in reducing exacerbations in patients with severe asthma and an eosinophilic phenotype, regardless of any overlapping allergic phenotype.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".