P93 Response to reslizumab in severe asthma patients unresponsive to mepolizumab or with suspected vasculitis

IntroductionReslizumab is the second biologic available targeting Interleukin 5 (IL5), for the management of severe eosinophilic asthma. We use it in patients who have failed to respond to mepolizumab or with suspected vasculitis.AimsTo determine the efficacy of reslizumab in reducing steroid dose and exacerbation rate (as well as e.g.: blood eosinophils, FEV1, weight) in patients previously unresponsive to mepolizumab (with proven persistent airway eosinophilia), or in selected anti-IL5-naive patients with suspected vasculitis.MethodsMaintenance prednisolone dose and exacerbation history were prospectively recorded at baseline (Bas) and at six months (6M), along with weight, blood eosinophils, lung function, Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Questionnaire (ACQ), fractional concentration of expired nitric oxide (FeNO). The data were analysed retrospectively. In view of the small number of patients descriptive statistics only are reported.ResultsBetween January 2018 and April 2019, 17 severe asthma patients had received at least one reslizumab infusion: nine of these were anti-IL5-naive and eight had previously been unresponsive to mepolizumab. This latter group had worse AQLQ (2.6), exacerbations (4.5) and lung function (53% predicted) at baseline compared to the naive group (3.2, 1 and 59% respectively).Sixteen patients completed at least six months treatment, with the remaining patient stopping due to an adverse reaction (rash). In previous mepolizumab-failed patients, reslizumab reduced the median daily prednisolone dose from 20 to 15 mg over 6-months, and from 17.5 to 15 mg in the biologic-naive group.SummaryReslizumab appears to be an effective medication in reducing prednisolone use in patients who had failed mepolizumab, or who were considered too severe for mepolizumab at the UK licensed dose (patients with suspected of vasculitis). A larger population and for a longer duration of follow-up are needed to confirm these real-life patient findings.