Mepolizumab, a monoclonal antibody targeting interleukin-5, significantly reduces systemic corticosteroid exposure in COPD patients with type 2 inflammation, cutting yearly steroid use by up to 42% compared to placebo across multiple clinical trials.
- Mepolizumab reduced mean annual systemic corticosteroid exposure from 609.95 mg to 434.64 mg in patients with blood eosinophil counts of 150 cells/mL or higher
- For patients with higher eosinophil counts (≥300 cells/mL), steroid exposure dropped from 551.52 mg to 354.28 mg annually with mepolizumab treatment
- Patients receiving mepolizumab spent significantly fewer days on high-dose systemic corticosteroids compared to placebo groups
- The analysis pooled data from three phase 3 randomized controlled trials (METREX, METREO, and MATINEE) involving over 2,000 COPD patients
- Mepolizumab (Nucala) was approved by the FDA in 2025 and has received regulatory approval in Canada and Europe for COPD treatment
Treatment guidelines for COPD recommend systemic corticosteroids (SCS) for exacerbations, but these medications can lead to complications. Mepolizumab, a humanized monoclonal antibody that specifically targets interleukin-5, has been found to reduce the total yearly SCS exposure in COPD patients with type 2 inflammation.
That’s according to an analysis of three studies that was presented at the CHEST Annual Meeting 2026 in Phoenix, Arizona. The abstract included the study, “Mepolizumab Reduces Systemic Corticosteroid Utilization in Chronic Obstructive Pulmonary Disease: Post-Hoc Analysis of the Phase III MATINEE Study,” which was published in CHEST.
According to a news release, researchers conducted a pooled analysis of data from three phase 3, randomized, placebo-controlled trials: METREX, METREO and MATINEE.
The MATINEE findings were outlined in the paper, “Mepolizumab to Prevent Exacerbations of COPD With an Eosinophilic Phenotype,” which was published in The New England Journal of Medicine. The results for METREO and METREX were outlined in the paper, “Mepolizumab for Eosinophilic Chronic Obstructive Pulmonary Disease,” also published in The New England Journal of Medicine.
Eligible patients in the pooled analysis were aged 40 years and older, had a COPD diagnosis for at least a year, were receiving inhaled triple therapy, had a history of COPD exacerbations and no diagnosis of asthma. Patients used for the analysis received 100 mg of mepolizumab subcutaneously or a placebo every four weeks. The analysis of the studies examined the percentage of days receiving SCS and total SCS exposure for any cause.
Among more than 2,000 patients enrolled, 1,713 had blood eosinophil counts (BEC) greater than or equal to 150 cells/mL, and 1,444 had BEC greater than or equal to 300 cells/mL. For patients in the lower eosinophil count group, the mean total SCS exposure was 434.64 mg/year with mepolizumab, compared to 609.95 mg/year with placebo. For those in the higher eosinophil count group, the mean total SCS exposure was 354.28 mg/year with mepolizumab, compared to 551.52 mg/year with placebo.
The researchers also found that those treated with mepolizumab spent fewer days receiving high-dose SCS compared to those receiving placebo.
“Mepolizumab can serve as an add-on to inhaled triple therapy and may reduce SCS burden in COPD, particularly complications associated with short-term, high-dose courses, across a wide spectrum of screening BEC levels,” said Nicole Hanania, MD, MS, FCCP, lead author of the analysis and CHEST 2026 presenter.
Sold under the brand name Nucala, mepolizumab was recently approved for use as a COPD treatment by Health Canada as well as the European Commission. It was approved by the U.S. Food and Drug Administration in 2025.
