Real-World Effectiveness of Mepolizumab Initiation in Treating Asthma and Concurrent Chronic Obstructive Pulmonary Disease in the US.

INTRODUCTION: Mepolizumab reduces exacerbations in patients with asthma but real-world data on its effectiveness in asthma and concurrent chronic obstructive pulmonary disease (COPD) are limited. This study assessed the real-world impact of mepolizumab initiation in patients with asthma and concurrent COPD. METHODS: Retrospective, longitudinal analysis from the US Komodo Research claims database (January 2016-June 2023). Eligible patients (aged ≥ 12 years; ≥ 2 mepolizumab claims) had ≥ 1 asthma claim and were categorized as asthma with concurrent COPD (≥ 1 COPD claim) or asthma only. Outcomes assessed in the 12 months post- versus 12 months pre-mepolizumab initiation included annualized exacerbation rates, oral corticosteroid (OCS) dispensing and burst rates, and asthma- and COPD-related healthcare resource utilization (HCRU), and healthcare costs. RESULTS: A total of 2106 patients had asthma with concurrent COPD; 4674 asthma only. The annualized rate of exacerbations decreased by 50% post- versus pre-mepolizumab in patients with asthma and concurrent COPD {rate ratio [95% confidence interval (CI)]: 0.50 [0.48, 0.53]; P < 0.001}, and by 49% in patients with asthma only [0.51 (0.49, 0.53); P < 0.001]. The relative reduction [rate ratio (95% confidence interval)] in hospitalization-defined exacerbations was 52% [0.48 (0.42, 0.54); P < 0.001] and 41% [0.59 (0.52, 0.67); P < 0.001] in the asthma with concurrent COPD and asthma-only cohorts, respectively. Relative reductions of between 36 and 44% in OCS dispensing and bursts were observed across both cohorts (P < 0.001); relative reductions of 42-49% were observed across both cohorts in HCRU, including in hospitalizations and emergency room visits (P < 0.001). Mean total healthcare costs per patient per year in the asthma with concurrent COPD cohort were $11,770 (30,663) post- versus $23,771 (66,737) pre-mepolizumab initiation, corresponding to a cost difference (95% CI) of $-12,001 (-14,816, -9,186) (P < 0.001). CONCLUSION: In this analysis of a large US claims database, mepolizumab reduced exacerbations and overall disease burden in patients with asthma and concurrent COPD.