Mepolizumab reduces exacerbation rates in patients with COPD, high eosinophil levels
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Key takeaways:
- Researchers divided this patient population into those with vs. without chronic bronchitis at baseline.
- More patients receiving mepolizumab vs. placebo were classified as COPD Assessment Test responders.
SAN DIEGO — Among patients with COPD and heightened eosinophil levels, mepolizumab lowered annualized exacerbation rates, according to a presentation at the American Thoracic Society International Conference.
Further, both patients with and without chronic bronchitis saw benefits with mepolizumab (Nucala, GSK), according to researchers.
“The efficacy and safety of mepolizumab in patients with COPD has been investigated in two placebo-controlled phase 3 trials, METREX and METREO,” Frank C. Sciurba, MD, FCCP, director of the emphysema/COPD research center and the pulmonary function exercise physiology laboratory at University of Pittsburgh, and colleagues wrote.
Using data from the METREX and METREO trials, Sciurba and colleagues conducted a post-hoc analysis of patients with COPD aged at least 40 years who randomly received either 100 mg mepolizumab or placebo every 4 weeks along with inhaled corticosteroid-containing triple therapy.
Researchers specifically sought to determine the impact of mepolizumab on exacerbations, COPD-specific St. George’s Respiratory Questionnaire (SGRQ) scores and COPD Assessment Test (CAT) scores at 52 weeks in patients who had eosinophil levels of at least 300 cells/μL 12 months before the trial and/or levels of at least 150 cells/μL at screening. Patients could also have symptoms of chronic bronchitis.
Within this study population, 448 patients (57% with baseline chronic bronchitis) received mepolizumab and 448 patients (63% with baseline chronic bronchitis) received placebo.
Between baseline and week 52, patients with chronic bronchitis receiving mepolizumab vs. placebo had a 24% lower annualized rate of moderate/severe exacerbations (RR = 0.76; 95% CI, 0.62-0.92). Among patients without chronic bronchitis, this rate decreased by 8% with mepolizumab vs. placebo (RR = 0.92; 95% CI, 0.75-1.13).
In terms of the annualized rate of exacerbations that required an ED visit or hospitalization, patients with chronic bronchitis in the mepolizumab group had a 12% decrease in this rate (RR= 0.88; 95% CI, 0.57-1.36) compared with those in the placebo group. A similar result was observed among those without chronic bronchitis, with a 18% lower rate with mepolizumab vs. placebo (RR = 0.82; 95% CI, 0.5-1.35).
By week 52, patients receiving mepolizumab had baseline SGRQ scores that improved to a greater degree than placebo, and this was found in both those with chronic bronchitis (least-squares mean change, –4.6 points vs. –3.7 points) and those without chronic bronchitis (least-squares mean change, –2.6 points vs. –2 points).
Researchers further classified patients with at least a 4-point reduction in SGRQ total score as responders. Among those with chronic bronchitis, responders made up 43% of the mepolizumab group at week 52, whereas they only made up 37% of the placebo group. Similarly, a slightly greater proportion of patients without bronchitis receiving mepolizumab were responders than those receiving placebo (41% vs. 39%).
Lastly, the mepolizumab group had baseline CAT scores that improved to a greater degree than placebo at week 52 in the set of patients with chronic bronchitis (least-squares mean change, –2.3 points vs. –1.1 points). In contrast, higher CAT scores signaled more severe COPD, and those without chronic bronchitis in both the mepolizumab and placebo groups had increases in this score (least-squares mean change, 0.4 points vs. 1 point).
A CAT responder had at least a 2-point reduction in this score, and more patients receiving mepolizumab vs. placebo were responders in both the chronic bronchitis subgroups (with bronchitis, 46% vs. 37%; without bronchitis, 30% vs. 27%).