Monoclonal antibody therapy in chronic obstructive pulmonary disease: will it prevent hospitalizations?

Biologics in chronic obstructive pulmonary disease (COPD) are primed to revolutionize care, particularly in reducing exacerbations, an impact already demonstrated in eosinophilic asthma. Dupilumab, a monoclonal antibody targeting interleukin-4 receptor alpha (IL-4Rα), is licensed for use in patients with COPD with a raised blood eosinophil count. However, uncertainties remain regarding the magnitude of clinical benefit, particularly in comparison to anti-interleukin-5 (IL-5) therapies. A key question is whether these therapeutic agents can reduce the incidence of hospitalized exacerbations, which are strongly associated with poor prognosis, increased healthcare utilization, and mortality. IL-5 is a key cytokine that drives eosinophil development.2-4 Mepolizumab, a humanized monoclonal antibody targeting IL-5, has been shown to reduce exacerbations in eosinophilic asthma.5 The MATINEE trial investigated the efficacy and safety of mepolizumab compared with placebo in patients with COPD at risk of exacerbations with a blood eosinophil count ≥300 cells/μL.1 This phase 3, multinational, double-blind, randomized, placebo-controlled trial enrolled patients with COPD who experienced ≥1 exacerbation in the previous year, had an eosinophil count ≥300 cells/μL, and were on inhaled triple therapy. Participants were randomized in a 1:1 ratio to receive either 100 mg mepolizumab or placebo every 4 weeks for 52 to 104 weeks. Of 3306 patients screened, 804 patients were randomized (403 received mepolizumab, 401 received placebo).