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The DREAM trial evaluated mepolizumab, an anti-interleukin-5 monoclonal antibody, in patients with severe eosinophilic asthma. More than 600 participants were randomized to subcutaneous or intravenous mepolizumab at different doses or placebo over one year. Mepolizumab significantly reduced the rate of clinically significant asthma exacerbations, with benefit observed across the studied dosing groups. The trial helped establish eosinophilic inflammation as a therapeutically actionable phenotype and contributed to the broader transition toward biologic therapy for severe asthma. For HCPs, the practical lesson is that biologic treatment begins with correct phenotyping: frequent exacerbations, evidence of type 2 inflammation, steroid burden, and response to optimized inhaled therapy should all be considered. The study does not mean that every patient with an elevated eosinophil count needs a biologic; rather, it supports using biomarkers and clinical history to identify patients in whom targeted treatment is most likely to reduce exacerbations. This evidence maps directly onto the conference’s asthma phenotyping and biologics sessions and its debate on when earlier biologic therapy should be considered.
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The DREAM trial evaluated mepolizumab, an anti-interleukin-5 monoclonal antibody, in patients with severe eosinophilic asthma. More than 600 participants were randomized to subcutaneous or intravenous mepolizumab at different doses or placebo over one year. Mepolizumab significantly reduced the rate of clinically significant asthma exacerbations, with benefit observed across the studied dosing groups. The trial helped establish eosinophilic inflammation as a therapeutically actionable phenotype and contributed to the broader transition toward biologic therapy for severe asthma. For HCPs, the practical lesson is that biologic treatment begins with correct phenotyping: frequent exacerbations, evidence of type 2 inflammation, steroid burden, and response to optimized inhaled therapy should all be considered. The study does not mean that every patient with an elevated eosinophil count needs a biologic; rather, it supports using biomarkers and clinical history to identify patients in whom targeted treatment is most likely to reduce exacerbations. This evidence maps directly onto the conference’s asthma phenotyping and biologics sessions and its debate on when earlier biologic therapy should be considered.
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