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Understanding of the underlying disease mechanisms is improving and it is now clear that eosinophils play a complex pathophysiological role in a broad range of type 2 inflammatory diseases. Standard of care for these conditions often still includes oral corticosteroids (OCS) and\/or cytotoxic immune therapies, which are associated with debilitating side effects. Selective, biological eosinophil\u2010reducing agents provide treatment options that improve clinical symptoms associated with eosinophilic inflammation and reduce OCS use. Mepolizumab is a humanized monoclonal antibody that binds to and neutralizes interleukin\u20105, the major cytokine involved in eosinophil proliferation, activation, and survival. Mepolizumab is approved for the treatment of severe eosinophilic asthma, eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome. Additionally, the efficacy of add\u2010on mepolizumab has been observed in patients with severe chronic rhinosinusitis with nasal polyposis and chronic obstructive pulmonary disease with an eosinophilic phenotype. Here, we review the development, approval, and real\u2010world effectiveness of mepolizumab for the treatment of patients with severe eosinophilic asthma, from the DREAM to REALITI\u2010A studies, and describe how knowledge from this journey extended to the use of mepolizumab and other biologics across a broad spectrum of eosinophilic diseases.<\/jats:p>","DOI":"10.1111\/all.15056","type":"journal-article","created":{"date-parts":[[2021,8,17]],"date-time":"2021-08-17T04:35:56Z","timestamp":1629174956000},"page":"778-797","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":88,"title":["From DREAM to REALITI\u2010A and beyond: Mepolizumab for the treatment of eosinophil\u2010driven diseases"],"prefix":"10.1111","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4288-5973","authenticated-orcid":false,"given":"Ian D.","family":"Pavord","sequence":"first","affiliation":[{"name":"Nuffield Department of Medicine and Oxford Respiratory NIHR BRC University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth H.","family":"Bel","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Amsterdam UMC University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4645-5209","authenticated-orcid":false,"given":"Arnaud","family":"Bourdin","sequence":"additional","affiliation":[{"name":"INSERM 12 F\u2010CRIN Clinical Research Initiative In Severe Asthma: a Lever for Innovation &amp; Science (CRISALIS)  France"},{"name":"Service de Pneumologie and INSERM CNRS CHU Montpellier Universit\u00e9 de Montpellier  Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Chan","sequence":"additional","affiliation":[{"name":"Clinical Sciences GSK R&amp;D  Stockley Park UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph K.","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head &amp; Neck Surgery Eastern Virginia Medical School  Norfolk Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver N.","family":"Keene","sequence":"additional","affiliation":[{"name":"Biostatistics GSK  Brentford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark C.","family":"Liu","sequence":"additional","affiliation":[{"name":"Divisions of Allergy and Clinical Immunology, Pulmonary and Critical Care Medicine Johns Hopkins Asthma and Allergy Center  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Martin","sequence":"additional","affiliation":[{"name":"Global Medical Affairs GSK  Brentford UK"},{"name":"Institute for Lung Health University of Leicester  Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6924-4500","authenticated-orcid":false,"given":"Alberto","family":"Papi","sequence":"additional","affiliation":[{"name":"Research Center on Asthma and COPD University of Ferrara  Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Roufosse","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine H\u00f4pital Erasme Universit\u00e9 Libre de Bruxelles  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Steinfeld","sequence":"additional","affiliation":[{"name":"Respiratory Research &amp; Development GSK  Collegeville PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Wechsler","sequence":"additional","affiliation":[{"name":"Department of Medicine National Jewish Health Cohen Family Asthma Institute  Denver CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven W.","family":"Yancey","sequence":"additional","affiliation":[{"name":"Respiratory Therapeutic Area Unit GSK  Research Triangle Park NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,9,16]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrd3838"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminhematol.2012.01.005"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.2147\/JAA.S40244"},{"key":"e_1_2_13_5_1","unstructured":"GSK.Mepolizumab US prescribing information. 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