COMSA-MEWS: A simple quantitative algorithm for determining response to biologics in severe asthma, tested in a real-world mepolizumab study

Background A 5-domain composite C ore O utcome M easures set for S evere A sthma (COMSA) has been introduced for evaluation of treatment response [1]. Methods The COMSA evaluation strategy was tested in a real-world study of 78 severe asthmatics with blood eosinophilia taking mepolizumab. Exacerbations, oral corticosteroid (OCS) use, Forced Expiratory Volume in 1 s (FEV1), Asthma Quality of Life Questionnaire (AQLQ) score, and Asthma Control Questionnaire-5 (ACQ-5) results were determined before treatment and 4, 12, 24 and 36 months thereafter. Responses were quantified as the sum of changes in domains using both the relative CONFiRM (CompOsite iNdexes For Response in asthMa)[2] scale, where exacerbations and OCS use are given most weight, and MEWS (Modified Equal Weight Score), where each domain gives equal weight. Both scales use identical cut-offs for degree of change within domains. Results After one year, the MEWS scoring system classified 13% as non-responders, 28% as sufficient-responders, 40% as substantial-responders and 19% as super-responders. Using CONFiRM, the corresponding group stratification was 22%, 22%, 33% and 23%, respectively. Group assignments remained unchanged at 24 and 36 months, for 66% of patients in COMSA-MEWS and 68% in COMFiRM. Baseline exhaled nitric oxide (F E NO) was highest among the super-responders, whereas other type 2 markers were similar across the groups. Conclusion In this first real-world application, the COMSA stratification assigned patients into distinct, graded responder groups that may be used in clinical research and management of severe asthma. Although patient reported symptoms are given greater weight in COMSA-MEWS, the two algorithms performed similarly.