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Pavord ID, et al. Mepolizumab for severe eosinophilic asthma (DREAM). Lancet. 2012. PMID 22901886

One-paragraph summary

DREAM randomized 621 people aged 12–74 with recurrent severe attacks and eosinophilic inflammation to three intravenous mepolizumab doses or placebo for 13 four-weekly infusions. Clinically significant attack rates were 2.40/year with placebo and 1.24, 1.46 and 1.15 with 75, 250 and 750 mg. Relative reductions were 48% (95% CI 31–61), 39% (19–54) and 52% (36–64), respectively.

Key findings

  • Selecting recurrent-attack eosinophilic disease converted an earlier disappointing pathway into clear clinical efficacy.
  • Attack reduction occurred without a strong dose gradient across the studied range.
  • The primary benefit was prevention of systemic-steroid/ED/admission-defined events, not universal symptom normalization.

Limitations

  • Intravenous doses differ from current subcutaneous practice.
  • Eligibility enriched a severe eosinophilic subgroup; results do not apply to unselected asthma.
  • The trial did not establish long-term remission, withdrawal strategy or direct comparative superiority.

Why it matters

DREAM is the canonical precision-medicine lesson in asthma: target validity depended on matching drug mechanism to a reproducible treatable trait and outcome. It helped make blood/sputum eosinophilia and attack history central to biologic development.

Cited by wiki pages

  • overview
  • severe asthma and biologics
  • clinical trials landscape