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Meta-Analysis
. 2013;8(3):e59872.
doi: 10.1371/journal.pone.0059872. Epub 2013 Mar 27.

Efficacy of anti-interleukin-5 therapy with mepolizumab in patients with asthma: a meta-analysis of randomized placebo-controlled trials

Yao Liu  1 , Song Zhang, Dao-wei Li, Shu-juan Jiang
Affiliations
Meta-Analysis

Efficacy of anti-interleukin-5 therapy with mepolizumab in patients with asthma: a meta-analysis of randomized placebo-controlled trials

Yao Liu et al. PLoS One. 2013.

Erratum in

  • PLoS One. 2013;8(6). doi: 10.1371/annotation/8da4be4b-2de1-4c51-9c40-0f49dc212579

Abstract

Background: Interleukin (IL)-5 is believed to be a key cytokine in eosinophil inflammatory infiltration in asthma. Previous clinical trials have evaluated the efficacy and safety of mepolizumab, a monoclonal antibody against IL-5, in patients with asthma. However, most of these studies were small, the conclusions were inconsistent, and the precise effects are therefore debatable.

Methods: A meta-analysis of randomized placebo-controlled trials was conducted to evaluate the effect of intravenous infusion of mepolizumab on clinical outcomes in patients with asthma. Trials were searched in PubMed, Embase, Web of Science, Cochrane CENTRAL, Scopus, reviews, and reference lists of relevant articles. The outcome variables analyzed included eosinophil counts in blood and sputum, airways outcome measures, exacerbations, asthma control, and quality of life scores.

Results: Seven studies met final inclusion criteria (total n = 1131). From the pooled analyses, mepolizumab significantly reduced eosinophils in blood (MD -0.29×10(9)/L, 95% CI -0.44 to -0.14×10(9)/L, P = 0.0001) and sputum (MD -6.05%, 95% CI -9.34 to -2.77%, P = 0.0003). Mepolizumab was also associated with significantly decreased exacerbation risk than placebo (OR 0.30, 95%CI 0.13 to 0.67, P = 0.004), and with a significant improvement in the scores on the Asthma Quality of Life Questionnaire (AQLQ) (MD 0.26, 95% CI 0.03 to 0.49, P = 0.03) in patients with eosinophilic asthma. There were no statistical differences between the groups with respect to FEV1, PEF, or histamine PC20 (all P>0.05), and a non-significant trend for improvement in scores on the Juniper Asthma Control Questionnaire (JACQ) (MD -0.21, 95% CI -0.43 to 0.01, P = 0.06) in the mepolizumab group was observed.

Conclusions: Mepolizumab reduces the risk of exacerbations and improves quality of life in patients with eosinophilic asthma, but no significant improvement in lung function outcomes was observed. Further research is required to establish the possible role of anti-IL-5 as a therapy for asthma.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow of study identification, inclusion, and exclusion.
Figure 2
Figure 2. The effect of mepolizumab on blood eosinophils (×109/L).
Figure 3
Figure 3. The effects of mepolizumab on sputum eosinophils (%).
Figure 4
Figure 4. The effects of mepolizumab on FEV1 (L).
Figure 5
Figure 5. The effects of mepolizumab on FEV1% of predicted value.
Figure 6
Figure 6. The effects of mepolizumab on morning PEF (L/min).
Figure 7
Figure 7. The effects of mepolizumab on histamine PC20 (mg/ml).
Figure 8
Figure 8. The effects of mepolizumab on exacerbation rates.
Figure 9
Figure 9. The effects of mepolizumab on Juniper Asthma Control Questionnaire (JACQ).
Figure 10
Figure 10. The effects of mepolizumab on Asthma Quality of Life Questionnaire (AQLQ).
Figure 11
Figure 11. Risk of bias summary of included studies summary*.
*Review authors’ judgments about each risk of bias item for each included study.+is “yes”, 2 is “no”,? is “unclear”.
Figure 12
Figure 12. Begg’s funnel plot (with pseudo 95% CIs) of the 7 studies evaluated the effect of mepolizumab on blood eosinophils.
See this image and copyright information in PMC

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