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Original Article Oral Glucocorticoid-Sparing Effect of Mepolizumab in Eosinophilic Asthma Elisabeth H. Bel, M.D., Ph.D., Sally E. Wenzel, M.D., Philip J. Thompson, M.D., Charlene M. Prazma, Ph.D., Oliver N. Keene, M.Sc., Steven W.

Yancey, M.Sc., Hector G. Ortega, M.D., Sc.D., and Ian D.

Pavord, D.M., for the SIRIUS Investigators N Engl J Med 2014; 371:1189-1197 DOI: 10.1056/NEJMoa1403291. Methods In a randomized, double-blind trial involving 135 patients with severe eosinophilic asthma, we compared the glucocorticoid-sparing effect of mepolizumab (at a dose of 100 mg) with that of placebo administered subcutaneously every 4 weeks for 20 weeks. The primary outcome was the degree of reduction in the glucocorticoid dose (90 to 100% reduction, 75 to less than 90% reduction, 50 to less than 75% reduction, more than 0 to less than 50% reduction, or no decrease in oral glucocorticoid dose, a lack of asthma control during weeks 20 to 24, or withdrawal from treatment). Other outcomes included the rate of asthma exacerbations, asthma control, and safety. Results The likelihood of a reduction in the glucocorticoid-dose stratum was 2.39 times greater in the mepolizumab group than in the placebo group (95% confidence interval, 1.25 to 4.56; P=0.008). The median percentage reduction from baseline in the glucocorticoid dose was 50% in the mepolizumab group, as compared with no reduction in the placebo group (P=0.007). Despite receiving a reduced glucocorticoid dose, patients in the mepolizumab group, as compared with those in the placebo group, had a relative reduction of 32% in the annualized rate of exacerbations (1. Starwind 4 0 Serial Port there. 44 vs.