D2.172 - Effectiveness of Mepolizumab in patients with severe asthma and allergic rhinitis: Real-World Evidence from the TYREX Study

Asthma and rhinitis frequently coexist within the framework of the “global airway,” particularly in allergic patients.

Mepolizumab—an anti–interleukin-5 monoclonal antibody—has demonstrated efficacy in improving asthma control in severe T2 asthma, but its clinical impact and treatment effectiveness in severe asthma patients with comorbid allergic rhinitis (AR) is still being elucidated. 

TYREX is a multicenter, retrospective, observational study of severe asthma patients treated with mepolizumab for a period ranging from 12 months to more than 5 years.  In this post hoc analysis, patients were classified as having or not a diagnosis of AR based on clinical history. Baseline characteristics were described, and statistical comparisons of clinical variables were performed at 12 months and at study end to assess long-term treatment effects across both groups.

The TYREX study included 446 patients. At baseline, 87 had AR and 359 did not.

Patients with AR had higher baseline serum IgE levels than those without AR. Blood eosinophil counts and FeNO levels significantly decreased and remained suppressed throughout follow-up  with comparable reductions in patients with and without AR.

Asthma exacerbations were significantly reduced at 12 months and maintained at study end in both subgroups. Lung function was significantly enhanced during follow up, with no clinically relevant differences between patients with and without AR. Asthma control improved significantly across patient groups, with sustained increases in mean ACT scores and 75–80% of patients achieving a clinically meaningful ACT improvement (≥3 points). The proportion of patients with well-controlled asthma (ACT ≥20) increased significantly, regardless of AR status (Table 1).

Clinical remission rates (FEV1≥80 %, 0 exacerbations, no use of corticosteroids and ACT≥20) were similar in patients with and without AR, with an increase from 12 months until the end of follow-up. FEOS ratio was high in both cohorts, with no significant differences. No statistically significant differences were found between subgroups in any outcome.

In the TYREX study, the presence or absence of allergic rhinitis did not translate into clinically relevant differences in treatment response to mepolizumab These findings support the efficacy of the IL5 pathway in patients with severe asthma, regardless of the coexistence of allergic rhinitis.