Clinical and economic consequences of switching from omalizumab to mepolizumab in uncontrolled severe eosinophilic asthma

Abstract Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids (OCS), which worsen patients’ health and increase healthcare spending. The aim of this study was to assess the clinical and economic impact of switching from omalizumab (OMA) to mepolizumab (MEP) in patients...

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Autores principales: Giovanna Elisiana Carpagnano, Emanuela Resta, Massimiliano Povero, Corrado Pelaia, Mariella D’Amato, Nunzio Crimi, Nicola Scichilone, Giulia Scioscia, Onofrio Resta, Cecilia Calabrese, Girolamo Pelaia, Maria Pia Foschino Barbaro
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Publicado: Nature Portfolio 2021
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Acceso en línea:https://doaj.org/article/d722a816d07e45d5b82ef3965833a969
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spelling oai:doaj.org-article:d722a816d07e45d5b82ef3965833a9692021-12-02T11:37:26ZClinical and economic consequences of switching from omalizumab to mepolizumab in uncontrolled severe eosinophilic asthma10.1038/s41598-021-84895-22045-2322https://doaj.org/article/d722a816d07e45d5b82ef3965833a9692021-03-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-84895-2https://doaj.org/toc/2045-2322Abstract Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids (OCS), which worsen patients’ health and increase healthcare spending. The aim of this study was to assess the clinical and economic impact of switching from omalizumab (OMA) to mepolizumab (MEP) in patients eligible for both biologics, but not optimally controlled by omalizumab. We retrospectively enrolled uncontrolled severe asthmatic patients who switched from OMA to MEP during the last two years. Information included blood eosinophil count, asthma control test (ACT), spirometry, serum IgE, fractional exhaled nitric oxide (FeNO), OCS intake, drugs, exacerbations/hospitalizations, visits and diagnostic exams. Within the perspective of Italian National Health System, a pre- and post-MEP 12-month standardized total cost per patient was calculated. 33 patients were enrolled: five males, mean age 57 years, disease onset 24 years. At OMA discontinuation, 88% were OCS-dependent with annual mean rate of 4.0 clinically significant exacerbations, 0.30 exacerbations needing emergency room visits or hospitalization; absenteeism due to disease was 10.4 days per patient. Switch to MEP improved all clinical outcomes, reducing total exacerbation rate (RR = 0.06, 95% CI 0.03–0.14), OCS-dependent patients (OR = 0.02, 95% CI 0.005–0.08), and number of lost working days (Δ = − 7.9, 95% CI − 11.2 to − 4.6). Pulmonary function improved, serum IgE, FeNO and eosinophils decreased. Mean annual costs were €12,239 for OMA and €12,639 for MEP (Δ = €400, 95% CI − 1588–2389); the increment due to drug therapy (+ €1,581) was almost offset by savings regarding all other cost items (− €1,181). Patients with severe eosinophilic asthma, not controlled by OMA, experienced comprehensive benefits by switching to MEP with only slight increases in economic costs.Giovanna Elisiana CarpagnanoEmanuela RestaMassimiliano PoveroCorrado PelaiaMariella D’AmatoNunzio CrimiNicola ScichiloneGiulia SciosciaOnofrio RestaCecilia CalabreseGirolamo PelaiaMaria Pia Foschino BarbaroNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Giovanna Elisiana Carpagnano
Emanuela Resta
Massimiliano Povero
Corrado Pelaia
Mariella D’Amato
Nunzio Crimi
Nicola Scichilone
Giulia Scioscia
Onofrio Resta
Cecilia Calabrese
Girolamo Pelaia
Maria Pia Foschino Barbaro
Clinical and economic consequences of switching from omalizumab to mepolizumab in uncontrolled severe eosinophilic asthma
description Abstract Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids (OCS), which worsen patients’ health and increase healthcare spending. The aim of this study was to assess the clinical and economic impact of switching from omalizumab (OMA) to mepolizumab (MEP) in patients eligible for both biologics, but not optimally controlled by omalizumab. We retrospectively enrolled uncontrolled severe asthmatic patients who switched from OMA to MEP during the last two years. Information included blood eosinophil count, asthma control test (ACT), spirometry, serum IgE, fractional exhaled nitric oxide (FeNO), OCS intake, drugs, exacerbations/hospitalizations, visits and diagnostic exams. Within the perspective of Italian National Health System, a pre- and post-MEP 12-month standardized total cost per patient was calculated. 33 patients were enrolled: five males, mean age 57 years, disease onset 24 years. At OMA discontinuation, 88% were OCS-dependent with annual mean rate of 4.0 clinically significant exacerbations, 0.30 exacerbations needing emergency room visits or hospitalization; absenteeism due to disease was 10.4 days per patient. Switch to MEP improved all clinical outcomes, reducing total exacerbation rate (RR = 0.06, 95% CI 0.03–0.14), OCS-dependent patients (OR = 0.02, 95% CI 0.005–0.08), and number of lost working days (Δ = − 7.9, 95% CI − 11.2 to − 4.6). Pulmonary function improved, serum IgE, FeNO and eosinophils decreased. Mean annual costs were €12,239 for OMA and €12,639 for MEP (Δ = €400, 95% CI − 1588–2389); the increment due to drug therapy (+ €1,581) was almost offset by savings regarding all other cost items (− €1,181). Patients with severe eosinophilic asthma, not controlled by OMA, experienced comprehensive benefits by switching to MEP with only slight increases in economic costs.
format article
author Giovanna Elisiana Carpagnano
Emanuela Resta
Massimiliano Povero
Corrado Pelaia
Mariella D’Amato
Nunzio Crimi
Nicola Scichilone
Giulia Scioscia
Onofrio Resta
Cecilia Calabrese
Girolamo Pelaia
Maria Pia Foschino Barbaro
author_facet Giovanna Elisiana Carpagnano
Emanuela Resta
Massimiliano Povero
Corrado Pelaia
Mariella D’Amato
Nunzio Crimi
Nicola Scichilone
Giulia Scioscia
Onofrio Resta
Cecilia Calabrese
Girolamo Pelaia
Maria Pia Foschino Barbaro
author_sort Giovanna Elisiana Carpagnano
title Clinical and economic consequences of switching from omalizumab to mepolizumab in uncontrolled severe eosinophilic asthma
title_short Clinical and economic consequences of switching from omalizumab to mepolizumab in uncontrolled severe eosinophilic asthma
title_full Clinical and economic consequences of switching from omalizumab to mepolizumab in uncontrolled severe eosinophilic asthma
title_fullStr Clinical and economic consequences of switching from omalizumab to mepolizumab in uncontrolled severe eosinophilic asthma
title_full_unstemmed Clinical and economic consequences of switching from omalizumab to mepolizumab in uncontrolled severe eosinophilic asthma
title_sort clinical and economic consequences of switching from omalizumab to mepolizumab in uncontrolled severe eosinophilic asthma
publisher Nature Portfolio
publishDate 2021
url https://doaj.org/article/d722a816d07e45d5b82ef3965833a969
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