Nonadherence to inhaled corticosteroids is associated with negative mepolizumab response.
4 affiliations
- 1Respiratory Department, Heartlands Birmingham University Hospitals NHS Trust, Birmingham, UK.
- 2Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia.
- 3Pharmacology School, University of Birmingham, Birmingham, UK.
- 4Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Abstract
Background
Nonadherence to inhaled corticosteroids (ICS) in severe asthma is associated with poor control and may impair response to biologics. The primary objective of the present study was to evaluate ICS nonadherence influence on mepolizumab treatment response in adults with severe eosinophilic asthma.Methods
In this retrospective cohort study, we compared ICS nonadherence rates in mepolizumab responders and nonresponders. Adherence was determined using a prescription possession ratio (PPR) of ≥75% to indicate adherence. Mepolizumab response was assessed using the positive response criteria of a ≥50% reduction in exacerbations and/or in the maintenance oral corticosteroid dose. Predictors of adherence and mepolizumab response were explored using standard statistics.Results
A total of 190 participants were included in the analysis (enrolment mean±sd age 52±13 years, 59 (31%) males). There were 153 (80%) responders to mepolizumab who displayed lower median exacerbations than the nonresponders (1 (interquartile range (IQR) 0, 2) versus 4 (IQR 2, 7); p=0.002). ICS nonadherence was detected in 30% and 26% of participants prior to and during mepolizumab treatment respectively. ICS nonadherence was more common in nonresponders 12/23 (52%) than in mepolizumab responders 29/130 (22%), p=0.002. Nonadherent patients had higher exhaled nitric oxide fraction (F ENO) (ppb) than the adherent patients (median 57 (IQR 35, 81) versus 34 (IQR 21, 61); p=0.009). Pre-mepolizumab nonadherence correlated significantly with on-treatment nonadherence (r=0.75, 95% CI 0.67-0.81; p<0.0001).Conclusions
ICS nonadherence was associated with negative response to mepolizumab treatment and raised F ENO levels compared to the adherent group. Our findings support the notion for the need for optimisation of ICS adherence during mepolizumab therapy.
Related
- 726 Soluble HVEM is associated with pathological complete response in triple-negative breast cancer
- Rituximab and corticosteroids for M-protein-negative PGNMID: case report.
- Palmitate-activated IRE1-XBP1 signaling limits DNA damage and is associated with H2A.X-linked DNA damage response transcripts in triple-negative breast cancer cells
- Antenatal Corticosteroids in Gestational Diabetes: A Systematic Review of Glycemic Response and Management Strategies
- Derived metabolic indices and poor early response to corticosteroids in adults with primary immune thrombocytopenia: a retrospective cohort study
BibTeX
@article{almutairi2026nonadherence,
title = {{Nonadherence to inhaled corticosteroids is associated with negative mepolizumab response.}},
author = {Mohammed Ghazi Almutairi and John Marriott and Zahraa Jalal and Louise Wood and Samantha Caddick and Babita Rajkumari and Susan Renwick and Siobhan Wilkinson and Caroline Gallagher and Hollie Morgan and Adel H Mansur},
journal = {ERJ open research},
year = {2026},
month = sep,
doi = {10.1183/23120541.00135-2026},
url = {https://europepmc.org/article/MED/42898776},
note = {CC BY},
}
RIS
TY - JOUR
TI - Nonadherence to inhaled corticosteroids is associated with negative mepolizumab response.
AU - Mohammed Ghazi Almutairi
AU - John Marriott
AU - Zahraa Jalal
AU - Louise Wood
AU - Samantha Caddick
AU - Babita Rajkumari
AU - Susan Renwick
AU - Siobhan Wilkinson
AU - Caroline Gallagher
AU - Hollie Morgan
AU - Adel H Mansur
PY - 2026
DA - 2026/09/01
JO - ERJ open research
DO - 10.1183/23120541.00135-2026
UR - https://europepmc.org/article/MED/42898776
AB - Background Nonadherence to inhaled corticosteroids (ICS) in severe asthma is associated with poor control and may impair response to biologics. The primary objective of the present study was to evaluate ICS nonadherence influence on mepolizumab treatment response in adults with severe eosinophilic asthma.Methods In this retrospective cohort study, we compared ICS nonadherence rates in mepolizumab responders and nonresponders. Adherence was determined using a prescription possession ratio (PPR) of ≥75% to indicate adherence. Mepolizumab response was assessed using the positive response criteria of a ≥50% reduction in exacerbations and/or in the maintenance oral corticosteroid dose. Predictors of adherence and mepolizumab response were explored using standard statistics.Results A total of 190 participants were included in the analysis (enrolment mean±sd age 52±13 years, 59 (31%) males). There were 153 (80%) responders to mepolizumab who displayed lower median exacerbations than the nonresponders (1 (interquartile range (IQR) 0, 2) versus 4 (IQR 2, 7); p=0.002). ICS nonadherence was detected in 30% and 26% of participants prior to and during mepolizumab treatment respectively. ICS nonadherence was more common in nonresponders 12/23 (52%) than in mepolizumab responders 29/130 (22%), p=0.002. Nonadherent patients had higher exhaled nitric oxide fraction (F ENO) (ppb) than the adherent patients (median 57 (IQR 35, 81) versus 34 (IQR 21, 61); p=0.009). Pre-mepolizumab nonadherence correlated significantly with on-treatment nonadherence (r=0.75, 95% CI 0.67-0.81; p<0.0001).Conclusions ICS nonadherence was associated with negative response to mepolizumab treatment and raised F ENO levels compared to the adherent group. Our findings support the notion for the need for optimisation of ICS adherence during mepolizumab therapy.
SN - 2312-0541
ER -