RT Journal Article SR Electronic T1 Characteristics of new adult users of mepolizumab with asthma in the USA JF BMJ Open Respiratory Research JO BMJ Open Resp Res FD British Thoracic Society SP e001003 DO 10.1136/bmjresp-2021-001003 VO 8 IS 1 A1 Ann Chen Wu A1 Pamela M McMahon A1 Emily Welch A1 Cheryl N McMahill-Walraven A1 Aziza Jamal-Allial A1 Mia Gallagher A1 Tancy Zhang A1 Christine Draper A1 Anne Marie Kline A1 Leslie Koerner A1 Jeffrey S Brown A1 Melissa K Van Dyke YR 2021 UL http://bmjopenrespres.bmj.com/content/8/1/e001003.abstract AB Background In the USA, over 25 million people have asthma; 5%–10% of cases are severe. Mepolizumab (Nucala) is an interleukin-5 antagonist monoclonal antibody; it was approved by the FDA in 2015 as add-on maintenance treatment of severe asthma for patients aged ≥12 years with an eosinophilic phenotype.Objectives (1) Describe baseline demographic and clinical characteristics of new US adult mepolizumab users 2015–2019, (2) describe asthma medication use in the 12 months preceding initiation of and concomitant with mepolizumab and (3) assess mepolizumab adherence, persistence and discontinuation patterns in 12 months postinitiation.Methods We conducted a new-user observational cohort study using data from Aetna, a CVS Health Company, HealthCore (Anthem), Harvard Pilgrim Healthcare, and IBM MarketScan Research Databases. Curated administrative claims data in the FDA Sentinel System common data model format and publicly available Sentinel analytical tools were used to query the databases. We included adults who initiated mepolizumab in 2015–2019 with an asthma diagnosis in the preceding 12 months and no evidence of cystic fibrosis. We examined age, sex, comorbid conditions, asthma medication use and severe asthma exacerbations.Results We identified 3496 adults (mean age 54.2 years, SD 12.5 years) who initiated mepolizumab. In the 12 months before mepolizumab initiation, 22% had received inhaled corticosteroids, 46% had inhaled corticosteroid/long-acting beta agonists, 72.6% had leukotriene antagonists, 38% had long-acting muscarinic antagonist, 18% had omalizumab,<1% had reslizumab, dupilumab or benralizumab. In the previous 12 months, 70% had a diagnosis of allergic rhinitis, 32% had chronic obstructive pulmonary disease, 17% eosinophilia and 3% eosinophilic granulomatosis with polyangiitis. Further, 56% had an asthma-related ambulatory visit, 73%≥1 course of oral corticosteroids lasting 3–27 days, 10% an asthma-related emergency department visit and 22% an asthma-related hospitalisation. In the 12 months following initiation, the mean proportion of days covered was 70%, and reductions in the average mean dispensings of rescue oral corticosteriods (35%) and omalizumab (61%) were observed.Conclusions Adults with asthma treated with mepolizumab had varying levels of healthcare utilisation and we observed evidence of mepolizumab use in patients without severe asthma.Data are available on reasonable request.