2023-07-27 11:15:00
Mepolizumab is a precision therapy for eosinophilic diseases, i.e. a whole series of pathologies, apparently distant from each other, which however have a common basis, namely the inflammation caused by an excessive presence of eosinophils, white blood cells involved in the immune response. Research in recent years has concentrated its efforts to find new therapies capable of being effective in various pathologies such as asthma, rhinosinusitis with nasal polyposis, but also other rare pathologies, in particular eosinophilic granulomatosis with polyangiitis.
Mepolizumab is the first monoclonal antibody to be reimbursed in Italy for three other pathologies in addition to severe asthma. “It can be defined as a precision treatment because it has a ‘focused’ target – explains Adriano Vaghi, former director of the Pneumology Unit, Asst Rhodense PO D. Garbagnate Milanese -. It is in fact a biological drug that affects various pathologies, all united by the excessive presence of eosinophils, such as interlukina 5, a protein produced by the cells of the immune system which carries out an etiopathogenetic action prevalent in serious pathologies, such as severe asthma eosinophilia, chronic rhinosinusitis with nasal polyposis but also in more complex pathologies such as eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome”.
It is therefore an important innovation for patients. “Today, with a single drug it is possible to treat several pathologies characterized by eosinophilia and by an overexpression of interlukinum 5 – continues Vaghi -. Furthermore, Mepolizumb has been shown to be absolutely well tolerated in the long term, with a significant reduction in symptoms, even in patients with severe asthma, and in some cases remission of the pathology”.
Tolerance and the possibility of treating multiple pathologies in the same subject therefore represent an added value. “Finally, also for this category of patients, since they are complex diseases, a multidisciplinary approach is essential, in which the various specialist doctors collaborate with each other in order to be able to offer the best therapies – concludes the expert – also because often these are patients who present comorbidity”.
Eosinophilic granulomatosis with polyangiitis is a rare systemic inflammatory disease belonging to the group of vasculitis of small to medium-sized blood vessels that can lead to organ damage. Symptoms of the disease affect the respiratory tract and include extreme fatigue, muscle and joint pain, weight loss, sinus symptoms, and shortness of breath. Until now, this pathology was treated with systemic corticosteroids and immunosuppressants, drugs with serious side effects. But a new weapon is now available.
“Corticosteroids remain and are still today the main corner of therapy for this pathology – explains Alvise Berti, researcher at the Interdepartmental Center for Medical Sciences, Department of Cellular, Computational and Integrative Biology, University of Trento -. And depending on the severity of the disease, immunosuppressants are added. The benefits that corticosteroids have on the disease are certainly important, but there are also serious problems, due to the cumulative dosage that corticosteroids can cause in the long term, such as cardiovascular hypertension, osteoporosis, diabetes mellitus and other complications”.
In 2017, thanks to a study, it was possible to appreciate the effectiveness of a new monoclonal antibody: mepolizumab. “There is a single, predominant etiopathogenetic factor in the genesis of this disease: the excessive presence of eosinophils, those cells that normally have the function of counteracting invading germs, such as parasites, bacteria or viruses, and promoting inflammation – continues Berti – . The therapy must therefore include precision treatments that are able to act specifically on the triggering cause, such as interleukin-5, a protein produced by cells of the immune system that favors the development, proliferation and survival of eosinophils. Mepolizumab with its direct mechanism of action on Interleukin 5 is a biological drug capable of reducing not only corticosteroid dosages, but also relapses, leading in some cases to complete remission of the disease”.
The Mirra study demonstrated the efficacy and safety of this molecule. “Published in the prestigious New England Journal of medicine, this is a phase III study conducted on 136 patients which demonstrates how Mepolizumab, at a dosage of 300 mg per month, allows to maintain remission for several weeks and to reduce probability of relapses and the dosage of corticosteroids to a measure lower than 4 mg per day, making it possible to avoid or greatly limit all the damages associated with the use of these drugs”, concludes the expert.
#Drugs #Mepolizumab #single #precision #therapy #eosinophilic #diseases