Reslizumab versus placebo for poorly controlled, severe eosinophilic asthma: meta-analysis

Miloš N. Milosavljević; Slobodan M. Jankovic; Ana V. Pejčić; Jasmina R. Milovanović; Valentina D. Opančina; Marina J. Kostić

doi:10.2298/VSP161124013M

Miloš N. Milosavljević University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
Slobodan M. Jankovic University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
Ana V. Pejčić University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
Jasmina R. Milovanović University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
Valentina D. Opančina University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
Marina J. Kostić University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP161124013M

Keywords: asthma;, eosinophilia;, anti-asthmatic agents;, reslizumab;, treatment outcome;, meta-analysis as topic.

Abstract

Background/Aim. Reslizumab is humanized monoclonal antibody produced by recombinant DNA technology which binds to circulating interleukin-5 (IL-5) and down-regulates the IL-5 signaling pathway. Reslizumab is indicated for the add-on maintenance treatment of patients 18 years and older with severe eosinophilic asthma phenotype whose symptoms were inadequately controlled with inhaled corticosteroids. The aim of this meta-analysis was to assess the efficacy and safety of reslizumab compared to placebo in patients suffering from inadequately controlled, moderate-to-severe asthma with elevated blood eosinophil counts. Methods. Our meta-analysis was based on systematic search of literature and selection of high-quality evidence according to pre-set inclusion and exclusion criteria. The effects of reslizumab and placebo were summarized using Review Manager (RevMan) 5.3.5 and heterogeneity was assessed by the Cochrane Q test and I² values. Several types of bias were assessed and publication bias shown by Funnel plot and Egger’s regression. Results. The meta-analysis included 5 randomized, placebo-controlled clinical trials. Reslizumab 3.0 mg/kg produced substantial improvements in forced expiratory volume in 1. second (FEV 1) (mean difference 0.15 [0.10, 0.21]) and in forced vital capacity (FVC) (mean difference 0.21 [0.09, 0.32]) over the 15 or 16-week treatment period, substantial decrease versus placebo in Asthma Control Questionnaire (ACQ) score (mean difference -0.28 [-0.41, -0.16]), and substantial increase vs. placebo from baseline in Asthma Quality of Life Questionnaire (AQLQ) total score (mean difference 0.24 [0.06, 0.43]). Also, reslizumab 3.0 mg/kg caused less adverse events versus placebo (OR 0.67 [0.51, 0.88]), especially asthma worsening (OR 0.53 [0.36, 0.77]) or bronchitis (OR 0.42 [0.24, 0.74]). Conclusion. On the basis of published clinical trials reslizumab could be considered as an effective and safe therapeutic option for severe, poorly controlled eosinophilic asthma for the time being.

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