Real-World Respiratory Effectiveness of mepolizumab in Severe Eosinophilic Asthma and Eosinophilic Granulomatosis with Polyangiitis

Wenjiao Zhu; Ke Chen; Ye Xiang; Jing Shi; Yiran Liang; Yueyang Tong; Siqi Wang; Hailuan Zeng; Lei Zhang; Xianhui Ning; Ling Ye; Meiling Jin

doi:10.1016/j.rmed.2025.108223

Real-World Respiratory Effectiveness of mepolizumab in Severe Eosinophilic Asthma and Eosinophilic Granulomatosis with Polyangiitis

Respir Med. 2025 Jun 26:108223. doi: 10.1016/j.rmed.2025.108223. Online ahead of print.

Authors

Wenjiao Zhu¹, Ke Chen¹, Ye Xiang¹, Jing Shi¹, Yiran Liang¹, Yueyang Tong², Siqi Wang¹, Hailuan Zeng¹, Lei Zhang³, Xianhui Ning⁴, Ling Ye⁵, Meiling Jin⁶

Affiliations

¹ Department of Allergy, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
² Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310000, China.
³ Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
⁴ Department of Otolaryngology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
⁵ Department of Allergy, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. Electronic address: ye.ling@zs-hospital.sh.cn.
⁶ Department of Allergy, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. Electronic address: mljin118@163.com.

PMID: 40581257
DOI: 10.1016/j.rmed.2025.108223

Abstract

Background: Severe eosinophilic asthma (SEA) and eosinophilic granulomatosis with polyangiitis (EGPA) share a common type 2 inflammatory pathway but differ in systemic involvement and corticosteroid dependence. Real-world data on mepolizumab's effectiveness in Chinese SEA and EGPA populations are limited, and no study has jointly evaluated both cohorts.

Methods: We conducted a single-center, retrospective cohort study of 38 consecutive SEA or EGPA patients treated with mepolizumab between July 2022 and February 2025 in China. Key outcomes included asthma exacerbation frequency, oral corticosteroid (OCS) use, lung function (FEV₁% predicted), and symptom control (ACQ-5, mini-AQLQ, SNOT-22) at baseline, 6 months, and 12 months. Safety and tolerability were also assessed.

Results: After 12 months, the proportion of patients with ≥1 exacerbation decreased from 66% to 14% (P<0.001), and median annual exacerbation rate fell from 2.0 (IQR 2.0-4.0) to 0.0 (IQR 0.0-0.8; P<0.001). OCS use declined from 63% to 23%, with median daily prednisone dose reduced from 10.0 mg to 5.0 mg (P<0.001). Mean FEV₁% predicted increased from 69.3% to 81.4% at 12 months (P=0.004); the SEA subgroup, characterized by more severe baseline obstruction, achieved a statistically significant FEV₁% predicted gain, whereas improvements in EGPA did not reach significance. Symptom scores (ACQ-5, mini-AQLQ, SNOT-22) improved significantly in both cohorts (all P<0.001). Two patients reported mild arthromyalgia.

Conclusion: In this real-world Chinese cohort, mepolizumab was well tolerated and associated with substantial reductions in exacerbations and OCS requirement, significant lung function gains, particularly in SEA, and marked symptom improvement in both SEA and EGPA.

Keywords: Eosinophilic airway inflammation; Mepolizumab; Severe eosinophilic asthma; eosinophilic granulomatosis with polyangiitis.