Mepolizumab

Mepolizumab Brand Name– Nucala

What is Mepolizumab

Mepolizumab is a subcutaneous interleukin (IL)-5 receptor antagonist monoclonal antibody (IgG1, kappa) indicated for add-on maintenance treatment of severe asthma with an eosinophilic phenotype and for the treatment of eosinophilic granulomatosis with polyangiitis (EGPA), which is also known as Churg-Strauss syndrome.

Mepolizumab is directed against IL-5, which is known to play an important role in regulating the function of eosinophils, an inflammatory cell responsible for airway inflammation in some types of asthma and EGPA.

Use of mepolizumab in patients with severe asthma (eosinophilic phenotype) led to fewer exacerbations requiring hospitalization and/or emergency department care and a longer time to the first exacerbation, compared to those who received placebo.

Clinical trial data indicated that mepolizumab use may also lead to a decrease in dosage of oral maintenance corticosteroids, while maintaining asthma control, for these patients.

Mepolizumab treatment did not result in a significant improvement in lung function, as measured by the volume of air exhaled in 1 second (FEV1), in premarketing randomized trials.

Among patients with relapsing or refractory EGPA and taking stable doses of prednisolone or prednisone, mepolizumab use resulted in more time in remission and a lower frequency of relapse compared to placebo, which allowed for a significantly lower glucocorticoid dose in the mepolizumab group.

Indications

  • asthma maintenance
  • Churg-Strauss syndrome

For asthma maintenance add-on therapy in severe asthma (eosinophilic phenotype)

Side Effects

  1. abdominal pain
  2. angioedema
  3. antibody formation
  4. asthenia
  5. back pain
  6. bronchospasm
  7. cystitis
  8. dental pain
  9. dizziness
  10. dyspnea
  11. fatigue
  12. fever
  13. flushing
  14. headache
  15. hypertension
  16. hypotension
  17. infection
  18. influenza
  19. injection site reaction
  20. muscle cramps
  21. musculoskeletal pain
  22. myalgia
  23. nasal congestion
  24. nausea
  25. pharyngitis
  26. pruritus
  27. rash
  28. rhinitis
  29. urticaria
  30. vomiting

Monitoring Parameters

  • pulmonary function tests (PFTs)

Contraindications

  • acute bronchospasm
  • breast-feeding
  • corticosteroid withdrawal
  • hamster protein hypersensitivity
  • helminth infection
  • herpes infection
  • pregnancy
  • status asthmaticus

Interactions

There are no drug interactions associated with Mepolizumab products.