Mepolizumab represents an effective strategy for severe eosinophilic asthma. Small airways disease (SAD) defines a peculiar asthma phenotype related to worse disease control. Limited and indirect findings are currently available on the effect of mepolizumab on SAD. Objectives: We investigated the impact of mepolizumab on SAD assessed through impulse oscillometry (IOS) and spirometry. As secondary outcomes, we tested the correlation between SAD and clinical, functional and inflammatory parameters. Methods: This is a prospective cohort study including severe eosinophilic asthmatics eligible for mepolizumab performed between 2021 and 2023. IOS (R5–R20) and spirometry (FEF25-75%, TLC%, RV/TLC%) parameters were assessed at baseline and over 1 year of mepolizumab. Other functional (FEV1%), clinical (ACT, number of asthma exacerbations/previous year, use of OCS) and inflammatory data (BEC and FeNO) were concomitantly collected for correlations. Results: A total of 18 patients (mean age 61.1 ± 12.0 y; 10 (55.5%) female) were included. Longitudinal data from 16 patients showed that R5–R20 significantly improved after 12-months treatment (p: 0.03), as well as FEF25-75% (p: 0.04) and TLC% (0.04). FEV1% and ACT showed a concomitant improvement (p: 0.03 and <0.01, respectively). All the steroid-dependent subjects discontinued OCS after 3 months and the percentage of subjects experiencing exacerbations significantly decreased (p: <0.01). As per drug effect, BEC consistently decreased (p: <0.01). The decrease in R5–R20 correlated with an improvement in FEF25-75% (r: −0.40 p: 0.048) and ACT at T12 (r: −0.59 p: 0.02). Conclusions: Twelve months treatment with mepolizumab improved R5–R20, suggesting its additional role as a targeted treatment for distal lung regions. This improvement also correlated with a clinically relevant amelioration of asthma symptoms.

Bonini, M., Boccabella, C., Cefaloni, F., De Corso, E., Donfrancesco, F., Schiavi, E., Richeldi, L., Small Airways Disease as a Novel Target for Mepolizumab in Asthma—The SASAM Prospective Real-Life Study, <<JOURNAL OF CLINICAL MEDICINE>>, 2025; 14 (9): 1-12. [doi:10.3390/jcm14092928] [https://hdl.handle.net/10807/315177]

Small Airways Disease as a Novel Target for Mepolizumab in Asthma—The SASAM Prospective Real-Life Study

Bonini, Matteo;Boccabella, Cristina;Cefaloni, Francesca;De Corso, Eugenio;Donfrancesco, Federico;Richeldi, Luca
Ultimo
2025

Abstract

Mepolizumab represents an effective strategy for severe eosinophilic asthma. Small airways disease (SAD) defines a peculiar asthma phenotype related to worse disease control. Limited and indirect findings are currently available on the effect of mepolizumab on SAD. Objectives: We investigated the impact of mepolizumab on SAD assessed through impulse oscillometry (IOS) and spirometry. As secondary outcomes, we tested the correlation between SAD and clinical, functional and inflammatory parameters. Methods: This is a prospective cohort study including severe eosinophilic asthmatics eligible for mepolizumab performed between 2021 and 2023. IOS (R5–R20) and spirometry (FEF25-75%, TLC%, RV/TLC%) parameters were assessed at baseline and over 1 year of mepolizumab. Other functional (FEV1%), clinical (ACT, number of asthma exacerbations/previous year, use of OCS) and inflammatory data (BEC and FeNO) were concomitantly collected for correlations. Results: A total of 18 patients (mean age 61.1 ± 12.0 y; 10 (55.5%) female) were included. Longitudinal data from 16 patients showed that R5–R20 significantly improved after 12-months treatment (p: 0.03), as well as FEF25-75% (p: 0.04) and TLC% (0.04). FEV1% and ACT showed a concomitant improvement (p: 0.03 and <0.01, respectively). All the steroid-dependent subjects discontinued OCS after 3 months and the percentage of subjects experiencing exacerbations significantly decreased (p: <0.01). As per drug effect, BEC consistently decreased (p: <0.01). The decrease in R5–R20 correlated with an improvement in FEF25-75% (r: −0.40 p: 0.048) and ACT at T12 (r: −0.59 p: 0.02). Conclusions: Twelve months treatment with mepolizumab improved R5–R20, suggesting its additional role as a targeted treatment for distal lung regions. This improvement also correlated with a clinically relevant amelioration of asthma symptoms.
2025
Inglese
Bonini, M., Boccabella, C., Cefaloni, F., De Corso, E., Donfrancesco, F., Schiavi, E., Richeldi, L., Small Airways Disease as a Novel Target for Mepolizumab in Asthma—The SASAM Prospective Real-Life Study, <<JOURNAL OF CLINICAL MEDICINE>>, 2025; 14 (9): 1-12. [doi:10.3390/jcm14092928] [https://hdl.handle.net/10807/315177]
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/315177
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 0
  • ???jsp.display-item.citation.isi??? 0
social impact