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Mepolizumab in Hypereosinophilic Syndrome: A Systematic Review and Meta-analysis

Authors
  • Alves, José Mario Júnior1
  • Prota, Francisco Eduardo1
  • Villagelin, Danilo1
  • Bley, Fernanda2
  • Bernardo, Wanderley Marques2, 3, 4
  • 1 Unimed Campinas Cooperativa de Trabalho Medico - Gestao e Valor em Saude, Campinas, SP, BR.
  • 2 Ebenezer Gestao em Saude - Medicina Baseada em Evidencia, Sao Paulo, SP, BR.
  • 3 Unimed Fesp - Federacao das Unimeds do Estado de Sao Paulo, Sao Paulo, SP, BR.
  • 4 Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR.
Type
Published Article
Journal
Clinics
Publisher
Faculdade de Medicina / USP
Publication Date
Sep 28, 2021
Volume
76
Identifiers
DOI: 10.6061/clinics/2021/e3271
PMCID: PMC8478134
Source
PubMed Central
Keywords
Disciplines
  • Review Article
License
Unknown

Abstract

We aimed to evaluate the efficacy and safety of mepolizumab (MEP) in the management of hypereosinophilic syndrome (HES). A systematic search was performed, and articles published until March 2021 were analyzed. The primary efficacy results evaluated were hospitalization rate related to HES, morbidity (new or worsening), relapses/failure, treatment-related adverse effects, prednisone dosage ≤10 mg/day for ≥8 weeks, and eosinophil count <600/μL for ≥8 weeks. A meta-analysis was conducted, when appropriate. Three randomized controlled trials (RCTs), with a total of 255 patients, were included. The studies contemplated the use of MEP 300 mg/SC or 750 mg/IV. According to the evaluation of the proposed outcomes, when relapse rates/therapeutic failures were assessed, there was a 26% reduction with MEP 300 mg/SC (RD=-0.26; 95% CI: -0.44 to -0.08; p =0.04) and 48% reduction with MEP 750 mg/IV (RD=-0.48; 95% CI: -0.67, -0.30; p <0.00001). For the outcomes, prednisone dosage ≤10 mg/day for ≥8 weeks was 48% (RD=0.48; 95% CI: 0.35 to 0.62; p <0.00001), and the eosinophil count <600/μL for ≥8 weeks was 51% (RD=0.51; 95% CI: 0.38 to 0.63; p <0.00001), both showed a reduction with MEP 300 mg/IV and 750 mg/IV. No statistically significant differences in treatment-related adverse effects outcomes were observed for either dosage (RD=0.09; 95% CI: -0.05 to 0.24; p =0.20; RD=0.09; 95% CI: -0.11 to 0.29; p =0.39). Despite the positive effects observed for the studied outcomes, the exact significance remains unclear.

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