Temporal trends in baseline severity and 12-month response to mepolizumab in severe asthma: The TYREX multicentre real-world study in Spain (2017–2024)

BACKGROUND AND OBJECTIVE: Although mepolizumab has demonstrated efficacy and effectiveness in the treatment of severe asthma, it is unknown whether the characteristics of patients starting this biologic have changed over the years and whether this impacts their response to mepolizumab. METHODS: TYREX was a multicenter, retrospective, observational study conducted in 24 asthma units across Spain to compare baseline clinical and demographic characteristics, and 12-month response to mepolizumab in two cohorts defined by the date of biologic initiation (cohort 1: 2017-2019 vs cohort 2: 2022-2024). RESULTS: Among the 446 patients included in the TYREX study, 191 were classified in cohort 1 and 108 in cohort 2. Cohort 1 had higher baseline exacerbation rates (3.45 vs. 2.40/year; p = 0.0002) and higher blood eosinophils (806 vs. 607 cells/μL; p = 0.0175). Twelve months after mepolizumab initiation, annual exacerbation rate were reduced to 0.46 in cohort 1 and to 0.51 in cohort 2, ACT scores increased from 14.23 to 21.84 vs. from 15.43 to 21.06; daily oral corticosteroid dependent patients dropped from 33.51% to 9.04% vs. from 12.96% to 2.78%; and clinical remission was achieved in 37.5% vs. 38.5% of patients after 12 months with mepolizumab. In multivariable analysis for 4-domain clinical remission (n = 108), higher baseline ppFEV1 increased the odds of remission while maintenance OCS use decreased them (Figure. 3). In the 3-domain remission model (n = 198), CRSwNP and higher baseline blood eosinophil count increased the odds of remission, whereas maintenance OCS use decreased them (Figure. 3). CONCLUSION: The decrease over time in severity and blood eosinophilia in asthma patients starting mepolizumab has not shown any impact on the clinical response to the drug.

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Journal
Respiratory Medicine
Published
2026-04-21
DOI
https://doi.org/10.1016/j.rmed.2026.108849
Primary Topic
Asthma and respiratory diseases
Type
article
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article

Temporal trends in baseline severity and 12-month response to mepolizumab in severe asthma: The TYREX multicentre real-world study in Spain (2017–2024)

Eusebi Chiner, Brian Vila Auli, Heleia González Cuervo, David Bañas-Conejero et al.
Respiratory Medicine
Asthma and respiratory diseases
article

Temporal trends in baseline severity and 12-month response to mepolizumab in severe asthma: The TYREX multicentre real-world study in Spain (2017–2024)

Eusebi Chiner, Brian Vila Auli, Heleia González Cuervo, David Bañas-Conejero, Ana Pueyo Bastida, Karima Khouadri, Cleofé Fernández-Aracil, Ignacio Boira, Carlos Almonacid, Ebymar Arismendi, Carolina Cisneros, Ismael García Moguel, Javier Domínguez‐Ortega, Mariana Muñoz‐Esquerre, Andrea Tristan, A. Gómez-Bastero Fernández, D. del Castillo Otero, María del Mar García-Ródenas, Tamara Hermida Valverde, David Espejo-Castellanos, H Flores, Juan Luis García-Rivero, Xavier Muñoz Gall, J. Gregorio Soto Campos, Esteban Antelo-Cea, Francisco Javier Alvarez-Gutiérrez, Nuria Marina Malanda, Luís Pérez de Llano, Rocío Magdalena Díaz Campos, Antonio León Lloreda, Adil Hannaoui Anaaoui, Belén Muñoz Sánchez, Beatriz Abascal-Bolado, Álvaro Cabeza Serrano, María Luisa Polonio González, Jorge Correa Borit, Gemma López-Sainz, Ma Angeles Zambonino, Marina Blanco-Aparicio, Jorge Rábago Castro, Ketherine Pose Silveira, Paula Rodriguez Siverio, Pilar Cuesta Apausa, Eva Martinez-Moragon, David Carlos Echevarría Kashmiri, Daniel Laorden Escudero, Ismael Ali-García, Ignacio Dávila
article en

Abstract

BACKGROUND AND OBJECTIVE: Although mepolizumab has demonstrated efficacy and effectiveness in the treatment of severe asthma, it is unknown whether the characteristics of patients starting this biologic have changed over the years and whether this impacts their response to mepolizumab. METHODS: TYREX was a multicenter, retrospective, observational study conducted in 24 asthma units across Spain to compare baseline clinical and demographic characteristics, and 12-month response to mepolizumab in two cohorts defined by the date of biologic initiation (cohort 1: 2017-2019 vs cohort 2: 2022-2024). RESULTS: Among the 446 patients included in the TYREX study, 191 were classified in cohort 1 and 108 in cohort 2. Cohort 1 had higher baseline exacerbation rates (3.45 vs. 2.40/year; p = 0.0002) and higher blood eosinophils (806 vs. 607 cells/μL; p = 0.0175). Twelve months after mepolizumab initiation, annual exacerbation rate were reduced to 0.46 in cohort 1 and to 0.51 in cohort 2, ACT scores increased from 14.23 to 21.84 vs. from 15.43 to 21.06; daily oral corticosteroid dependent patients dropped from 33.51% to 9.04% vs. from 12.96% to 2.78%; and clinical remission was achieved in 37.5% vs. 38.5% of patients after 12 months with mepolizumab. In multivariable analysis for 4-domain clinical remission (n = 108), higher baseline ppFEV1 increased the odds of remission while maintenance OCS use decreased them (Figure. 3). In the 3-domain remission model (n = 198), CRSwNP and higher baseline blood eosinophil count increased the odds of remission, whereas maintenance OCS use decreased them (Figure. 3). CONCLUSION: The decrease over time in severity and blood eosinophilia in asthma patients starting mepolizumab has not shown any impact on the clinical response to the drug.

Respiratory MedicineVol. 257
Universidad de Salamanca (ES), Hospital Universitario Insular de Gran Canaria (ES), Hospital Universitario de Canarias (ES), Hospital Universitario La Paz (ES), Bellvitge University Hospital (ES), Hospital Universitario Virgen Macarena (ES), Hospital Universitari Sant Joan D'Alacant (ES), Hospital Universitario de Gran Canaria Doctor Negrín (ES), Marqués de Valdecilla University Hospital (ES), Hospital Universitario 12 De Octubre (ES), Hospital La Paz Institute for Health Research (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), Hospital Clínic de Barcelona (ES), Hospital Universitario de Burgos (ES), Hospital Universitario Doctor Peset (ES), Vall d'Hebron Hospital Universitari (ES), Hospital Universitario de La Princesa (ES), Hospital Universitario Central de Asturias (ES), Hospital de Cruces (ES), Hospital General Universitario de Alicante Doctor Balmis (ES), Hospital Universitario Puerto Real (ES), Complexo Hospitalario Universitario A Coruña (ES), Hospital Universitario Lucus Augusti (ES), GlaxoSmithKline (Spain) (ES), Hospital Universitario Virgen del Rocío (ES), Hospital Jerez Puerta del Sur (ES), Hospital Marina Baixa (ES), Hospital Universitario Infanta Leonor (ES)
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