TY - JOUR T1 - P99 The value of oral prednisolone in patients with severe eosinophilic asthma on mepolizumab treatment JF - Thorax JO - Thorax SP - A141 LP - A141 DO - 10.1136/thorax-2020-BTSabstracts.244 VL - 76 IS - Suppl 1 AU - JF Yang AU - J Busby AU - LG Heaney AU - CE Brightling AU - ID Pavord AU - K Borg AU - PJ McDowell AU - S Diver AU - R Shrimanker AU - SJ Smith AU - M Shepherd AU - WN Lee AU - R Chaudhuri Y1 - 2021/02/01 UR - http://thorax.bmj.com/content/76/Suppl_1/A141.1.abstract N2 - Background Mepolizumab and prednisolone have overlapping anti-inflammatory effects so the clinical effects of prednisolone might be attenuated in severe eosinophilic asthma (SEA) patients treated with mepolizumab.Methods We tested this hypothesis in a randomized, double-blinded, placebo-controlled, crossover trial of prednisolone (0.5 mg/kg/day, 2 weeks) after ≥12 weeks of mepolizumab. Symptoms and quality of life (QoL) questionnaire scores, lung function including oscillometry and markers of inflammation were measured before and after prednisolone and placebo.Results There were no significant changes in asthma symptoms and QoL questionnaire scores following prednisolone treatment. In comparison to placebo, prednisolone improved FEV1 by 100 ml (p=0.019) and FEF25-75 by 200 ml/s (p=0.006). Median FeNO at baseline was 37ppb. Prednisolone reduced FeNO by 13.0ppb (p=0.001), blood eosinophil count by 0.02 × 109/L (p=0.003) and sputum eosinophil percentage of total cell count by 1.4% (p=0.002) in comparison to placebo. Post-prednisolone and post-placebo SNOT-20 questionnaire scores indicated there were no improvements in nasal symptoms following prednisolone in patients on mepolizumab.View this table:Abstract P99 Table 1 Prednisolone vs placebo response in patients with severe eosinophilic asthma treated with ≥12 weeks of mepolizumab (n=26)Conclusion In patients with severe eosinophilic asthma treated with mepolizumab, prednisolone has no significant effects on symptoms or quality of life but improves FEV1 and small airway function and reduces FeNO. ER -