Mepolizumab Lowers Systemic Corticosteroid Exposure in Eosinophilic COPD

Mepolizumab reduced total yearly exposure to systemic corticosteroids (SCS) compared with placebo in patients with chronic obstructive pulmonary disease (COPD) and elevated blood eosinophil counts (BEC), according to a pooled analysis of 3 phase 3 trials. The analysis was presented at the CHEST Annual Meeting 2026 and published as an abstract in a CHEST supplement.

The investigators noted that guidelines recommend SCS for COPD exacerbations, but SCS are associated with complications, highlighting a need for targeted treatments that reduce SCS burden. They described mepolizumab, a humanized monoclonal antibody that targets interleukin-5, as an approved add-on maintenance therapy for patients with COPD and an eosinophilic phenotype.

The GSK-funded analysis pooled data from the randomized, placebo-controlled METREX, METREO, and MATINEE trials. Patients 40 years or older who were receiving inhaled triple therapy, had a history of exacerbations, and had GOLD grade 2-4 airflow obstruction received mepolizumab 100mg subcutaneously or placebo every 4 weeks for 52 to 104 weeks. Of 2,089 enrolled patients, 1,713 had a BEC of at least 150cells/μL. In this group, mean total SCS exposure was 434.64mg/year with mepolizumab and 609.95mg/year with placebo (mean difference, 178.97mg/year; 95% CI, 62.09-292.19). Among 1,144 patients with a BEC of at least 300cells/μL, mean exposure was 354.28mg/year and 551.52mg/year, respectively.

In the group with a BEC of 150cells/μL or higher, the mean percentage of days on high-dose SCS (≥20mg/day prednisolone equivalent) was 4.5% with mepolizumab and 5.9% with placebo, while days on low-dose SCS were 5.7% in both arms. The mean percentage of days without SCS was 89.8% and 88.3%, respectively. The abstract did not report statistical comparisons for these day-based measures.

The investigators concluded that mepolizumab reduced total yearly SCS exposure, particularly high-dose courses, whether patients’ BEC was at least 150 or at least 300cells/μL. They said the therapy may reduce SCS burden in COPD across a wide spectrum of BEC levels. The findings were reported as a conference abstract.

Source: Hanania NA, Kraft M, Burrows E, Biswas A, Gould S, Min J. Mepolizumab reduces systemic corticosteroid utilization in COPD with type 2 inflammation: pooled results from phase 3 randomized trials. Chest. 2026;170(4 suppl):5187A. doi:10.1016/j.chest.2026.07.3950