Antibody Therapy Could Lessen Exacerbations in Certain COPD Patients

Treatment with mepolizumab, a monoclonal antibody, reduced the rate of moderate to severe exacerbations among patients with an eosinophilic phenotype, according to the results of a recent study.

As much as 40% of COPD patients have an eosinophilic phenotype, which is associated with an increased risk of exacerbations. While current Global Initiative for Chronic Obstructive Lung Disease treatment guidelines recommend maintenance using triple inhaled therapy, approximately 30% to 40% of patients reportedly continue to experience exacerbations.
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In 2 Phase III clinical trials—Mepolizumab vs Placebo as Add-on Treatment for Frequently Exacerbating COPD Patients (METREX) and Mepolizumab vs Placebo as Add-on Treatment for Frequently Exacerbating COPD Patients Characterized by Eosinophil Level (METREO)—researchers sought to determine the safety and efficacy of subcutaneous mepolizumab as an add-on to triple inhaled therapy, as well as the phenotypes of patients most likely to have a response to mepolizumab treatment.

In the METREX trial, 837 patients with COPD were stratified by blood eosinophil counts and randomly assigned to receive either 100 mg of mepolizumab or placebo, via subcutaneous injection, every 4 weeks for 52 weeks. Those patients with high eosinophil counts who received mepolizumab had an 18% lower rate of moderate to severe exacerbations than those in the placebo group.

In the METREO trial, 675 patients with elevated eosinophil levels were randomly assigned to receive 100 or 300 mg of mepolizumab or placebo every 4 weeks for 52 weeks. Overall, those with high eosinophil levels saw a 20% decreased risk of exacerbation compared with placebo, although the 300 mg dose was not associated with any advantage over lower dose.

“In conclusion, among patients with COPD who were already receiving maximal inhaled glucocorticoid–based triple inhaled maintenance therapy, mepolizumab resulted in lower rates of moderate or severe exacerbations than placebo and in longer times to a first exacerbation, and the extent of these effects was related to blood eosinophil count. With the use of mepolizumab as a targeted treatment to reduce blood eosinophil counts, these trials show the importance of blood eosinophils in COPD exacerbations,” the researchers concluded.

—Michael Potts

Reference:

Pavord ID, Chanez P, Criner GJ, et al. Mepolizumab for eosinophilic chronic obstructive pulmonary disease [published online September 12, 2017]. NEJM. doi: 10.1056/NEJMoa1708208.