COPD · Biologics for eosinophilic COPD
Mepolizumab to Prevent Exacerbations of COPD with an Eosinophilic Phenotype
| Design | Phase 3, double-blind, placebo-controlled RCT |
|---|---|
| Treatment | Mepolizumab, added to background triple inhaled therapy |
| Control | Placebo |
| Population | 804 patients with COPD and an eosinophilic phenotype |
| Follow-up | Up to 104 weeks |
| Primary endpoint | Annualised rate of moderate or severe exacerbations |
| Result | 0.80 versus 1.01 events per year (rate ratio 0.79, 95% CI 0.66 to 0.94, p=0.01). Median time to first moderate or severe exacerbation 419 versus 321 days (HR 0.77, 0.64 to 0.93, p=0.009). Differences in quality of life and symptoms were not significant, so no formal inference was drawn on the later endpoints in the testing hierarchy. Adverse events were similar. |
| Secondary endpoints | Time to first exacerbation, health-related quality of life, symptoms |
Treatment with mepolizumab led to a lower annualized rate of moderate or severe exacerbations when added to background triple inhaled therapy among patients with COPD and an eosinophilic phenotype.
The trial authors, in the published abstract
Confirms the eosinophilic COPD phenotype as treatable but with a smaller effect than BOREAS, and without the accompanying gain in symptoms or quality of life. The open question is which patients justify the cost of a biologic rather than optimised inhaled therapy.
Sciurba FC, Criner GJ, Christenson SA, et al. Mepolizumab to Prevent Exacerbations of COPD with an Eosinophilic Phenotype. N Engl J Med 2025 May 1;392(17):1710-1720.