Mepolizumab reduced both health care resource utilization (HCRU) and work productivity and activity impairment (WPAI) among patients with severe asthma in the real-world REALITA-A study.1 The findings, published in the Journal of Asthma, emphasize the real-world benefits of mepolizumab (Nucala; GSK) for severe eosinophilic asthma.
The economic burden of severe asthma, driven by frequent hospitalizations and productivity loss, represents a significant drain on health care systems and employers.2,3 The prospective REALITI-A study demonstrated that over 2 years of treatment, mepolizumab was associated with substantial and sustained reductions in both HCRU and WPAI for adult patients with severe eosinophilic asthma.1
The REALITI-A study enrolled 822 adult patients with severe asthma newly initiating subcutaneous mepolizumab (100 mg) and compared HCRU and WPAI outcomes during a 24-month follow-up period against the 12 months prior to treatment initiation. The study population reflected the complex nature of severe asthma management, with patients having a mean age of 54 years and a high baseline exacerbation rate, averaging 4.4 clinically significant events in the year before treatment.
The most notable outcome for HCRU was the sustained and significant decrease in acute care needs. Across the 24-month follow-up period, the rates of asthma-related hospitalizations, emergency department (ED) visits, and outpatient visits were all reduced by a statistically significant 59% to 64% (all P < .001) compared with the pre-treatment year. The rates of hospitalization saw a 53% reduction in the first 12 months, a benefit that was sustained through the second year. The mean number of overnight hospital stays per patient dropped from 2.4 in the year before treatment to 1 during the 12-month follow up and 0.5 at the 24-month follow-up, representing a decline in the most costly elements of severe asthma management. These results align with previous clinical trials and claims database data, consistently showing mepolizumab’s positive impact on HCRU.
Beyond direct medical costs, the study demonstrated significant improvements in patient function based on the WPAI questionnaire. Patients reported a 74% relative reduction in the score for overall work impairment by the 24-month mark, from a baseline mean of 38.2% to 9.8%. This improvement was driven by major decreases in 2 components: presenteeism (impairment while working) scores decreased by 75% relative to baseline, and absenteeism (work time missed) scores decreased by 70%. The mean activity impairment score, which assesses limitations in daily activities outside of work, also saw a substantial 55% relative decrease from baseline after 2 years of treatment.
While the strength of the observational study lies in its ability to reflect patient outcomes within routine clinical practice, a major benefit for informing real-world resource allocation decisions, the authors noted several limitations. First, patients had more comorbidities compared clinical trial populations, which have more specific enrollment criteria. Patients enrolled in REALITI-A likely also had slightly more severe asthma vs clinical trial populations because reimbursement criteria had to be met to be eligible to receive mepolizumab in the real-world setting. Missing data was another limitation, which is consistent with the study’s real-world setting and observational nature.
Still, the real-world data support the long-term value of mepolizumab as an add-on maintenance therapy. The sustained, significant mitigation of exacerbation-related HCRU—including hospitalizations and ED visits—combined with the impact on productivity and daily functioning, suggests that the drug may alleviate considerable cost-related burdens for health care systems and employers.
“The results of this analysis indicate that mepolizumab treatment reduced HCRU while improving activity and productivity in patients with severe asthma in a real-life setting over 2 years,” the authors concluded. “These data may be informative for health care system resource allocation.”
References
1. Canonica GW, Bourdin A, Penz E, Zhang L, Howarth P, Alfonso-Cristancho R. Mepolizumab reduced healthcare resource utilization and improved work productivity in patients with severe asthma during the REALITI-A 2-year study. J Asthma. Published online September 29, 2025. doi:10.1080/02770903.2025.2558755
2. Kerkhof M, Tran TN, Soriano JB, Golam S, Gibson D, Hillyer EV, Price DB. Healthcare resource use and costs of severe, uncontrolled eosinophilic asthma in the UK general population. Thorax. 2018;73(2):116-124. doi:10.1136/thoraxjnl-2017-210531
3. Song HJ, Blake KV, Wilson DL, Winterstein AG, Park H. Medical costs and productivity loss due to mild, moderate, and severe asthma in the United States. J Asthma Allergy. 2020;13:545-555. doi:10.2147/JAA.S272681
