Mepolizumab treatment and reduced oral corticosteroid exposure improves symptoms of depression and anxiety in severe eosinophilic asthma: data from the Australian Mepolizumab Registry
- PMID: 40912662
- DOI: 10.1016/j.rmed.2025.108340
Mepolizumab treatment and reduced oral corticosteroid exposure improves symptoms of depression and anxiety in severe eosinophilic asthma: data from the Australian Mepolizumab Registry
Abstract
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.
Keywords: Anxiety; Depression; Mepolizumab; Oral corticosteroid stewardship; Severe asthma.
Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Erin S Harvey reports financial support was provided by GlaxoSmithKline, paid to her employer. Peter G Gibson reports financial support was provided by GlaxoSmithKline. Peter G Gibson reports a relationship with GlaxoSmithKline that includes: payment or honoraria, and funding grants. Peter G Gibson reports a relationship with AstraZeneca that includes: payment or honoraria, and funding grants. Peter G Gibson reports a relationship with Sanofi that includes: payment or honoraria. Yuto Hamada reports a relationship with AstraZeneca that includes: payment or honoraria. David Langton reports a relationship with GlaxoSmithKline that includes: consulting or advisory. Dennis Thomas reports a relationship with GlaxoSmithKline that includes: funding grants, outside the submitted work. Vanessa M McDonald reports a relationship with GlaxoSmithKline that includes: consulting or advisory, payment or honoraria, and travel reimbursement. Vanessa M McDonald reports a relationship with Boehringer Ingelheim that includes: payment or honoraria, and travel reimbursement. Vanessa M McDonald reports a relationship with Menarini that includes: payment or honoraria, and travel reimbursement. Vanessa M McDonald reports a relationship with National Health and Medical Research Council that includes: funding grants. Vanessa M McDonald reports a relationship with Australian Government Medical Research Future Fund that includes: funding grants. Philip Bardin reports a relationship with Monash Lung and Sleep which includes: per patient trial participation fees during the conduct of this study. Philip Bardin reports fees for consulting or advisory, outside the submitted work. Matthew Peters reports a relationship with Sanofi Genzyme that includes: consulting or advisory, outside the submitted work. Matthew Peters reports a relationship with Novartis Pharmaceuticals that includes: consulting or advisory, outside the submitted work. Matthew Peters reports a relationship with AstraZeneca that includes: consulting or advisory, outside the submitted work. John W Upham reports a relationship with GlaxoSmithKline that includes: funding grants. John W Upham reports a relationship with Moderna that includes: consulting or advisory. John W Upham reports a relationship with AstraZeneca that includes: consulting or advisory, and payment or honoraria. John D Blakey reports relationships with GlaxoSmithKline, AstraZeneca, Chiesi, Boehringer-Ingelheim, Sanofi, and Asthma Australia for institutional and personal payments or in-kind benefit for educational, research, and advisory work from, outside the submitted work. Simon Bowler reports a relationship with GlaxoSmithKline that includes: consulting or advisory, outside the submitted work. Jimmy Chien reports a relationship with GlaxoSmithKline that includes: personal fees, outside the submitted work. Jimmy Chien reports a relationship with AstraZeneca that includes: consulting or advisory, outside the submitted work. Li Ping Chung reports a relationship with GlaxoSmithKline that includes: honorarium. Li Ping Chung reports a relationship with AstraZeneca that includes: honorarium. Li Ping Chung reports a relationship with Boehringer Ingelheim that includes: honorarium. Li Ping Chung reports a relationship with Sanofi that includes: honorarium. Li Ping Chung reports a relationship with Chiesi that includes: consulting or advisory, and funding grants, all outside the submitted work. Claude S Farah reports a relationship with AstraZeneca that includes: personal fees, outside the submitted work. Claude S Farah reports a relationship with Boehringer Ingelheim that includes: personal fees, outside the submitted work. Claude S Farah reports a relationship with GlaxoSmithKline that includes: personal fees, outside the submitted work. Claude S Farah reports a relationship with Sanofi Genzyme that includes: personal fees, outside the submitted work. Andrew Gillman reports a relationship with GlaxoSmithKline that includes: consulting or advisory, and speaking or lecture fees, outside the submitted work. John Harrington reports a relationship with AstraZeneca that includes: consulting or advisory, and speaking or lecture fees, outside the submitted work. John Harrington reports a relationship with Sanofi that includes: consulting or advisory, and speaking or lecture fees, outside the submitted work. John Harrington reports a relationship with GlaxoSmithKline that includes: consulting or advisory, and speaking or lecture fees, outside the submitted work. Mark Hew reports a relationship with AstraZeneca that includes: consulting or advisory, payment or honoraria, and funding grants. Mark Hew reports a relationship with GlaxoSmithKline that includes: consulting or advisory, payment or honoraria, and funding grants. Mark Hew reports a relationship with Novartis that includes: consulting or advisory, payment or honoraria, and funding grants. Mark Hew reports a relationship with Sanofi that includes: consulting or advisory, payment or honoraria, and funding grants. Mark Hew reports a relationship with Seqirus that includes: consulting or advisory. Mark Hew reports a relationship with Teva that includes: payment or honoraria. Mark Hew reports a relationship with Aravax that includes: consulting or advisory, all outside the submitted work and paid to his institutional employer, Alfred Health. Christine Jenkins reports relationships with AstraZeneca, Chiesi, GlaxoSmithKline, and Sanofi that include: consulting or advisory, conducting meetings, developing educational content, and travel reimbursement, outside the submitted work. Constance H Katelaris reports a relationship with GlaxoSmithKline that includes: funding grants, during the conduct of the study. Constance H Katelaris reports a relationship with Sanofi that includes: consulting or advisory, and speaking or lecture fees, outside the submitted work. Constance H Katelaris reports a relationship with Novartis that includes: consulting or advisory, and speaking or lecture fees, outside the submitted work. Constance H Katelaris reports a relationship with CSL that includes: consulting or advisory, and speaking or lecture fees, outside the submitted work. Constance H Katelaris reports a relationship with Sequirus that includes: personal fees, outside the submitted work. Constance H Katelaris reports a relationship with Takeda that includes: personal fees, outside the submitted work. Vicky Kritikos reports a relationship with GlaxoSmithKline that includes: funding grants. Vicky Kritikos reports a relationship with AstraZeneca that includes: payment or honoraria. Joy Lee reports a relationship with GlaxoSmithKline that includes: fees for unrelated independent medical advice, and speaking or lecture fees. Joy Lee reports a relationship with Boehringer Inglheim that includes: speaking or lecture fees. Joy Lee reports a relationship with AstraZeneca that includes: speaking or lecture fees. Naghmeh Radhakrishna reports a relationship with Sanofi that includes: funding grants. Naghmeh Radhakrishna reports a relationship with GlaxoSmithKline that includes: speaking or lecture fees. Naghmeh Radhakrishna reports a relationship with AstraZeneca that includes: speaking or lecture fees. Naghmeh Radhakrishna reports a relationship with Mundipharma that includes: speaking or lecture fees. Naghmeh Radhakrishna reports a relationship with Sanofi that includes: speaking or lecture fees. Naghmeh Radhakrishna reports a relationship with Mylan that includes: speaking or lecture fees. Peter A B Wark reports a relationship with GlaxoSmithKline that includes: funding grants. The rest of the authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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