Claus Vogelmeier, MD

Which data support mepolizumab’s benefit?

A pooled analysis of the phase 3 METREX, METREO, and MATINEE trials found that mepolizumab (GSK) reduced moderate or severe exacerbations in patients with eosinophilic

 (COPD) regardless of whether they were current or former smokers, though the drug's benefit on more serious outcomes appeared limited to former smokers, according to Claus F. Vogelmeier, MD, professor of medicine and head of the Department of Medicine, Pulmonary and Critical Care Medicine at the University Medical Center Giessen and Marburg. Vogelmeier discussed the pooled analysis, presented at the 

2026 European Respiratory Society (ERS) Congress

, held September 5 to 9 in Barcelona, Spain, in an interview with 

Mepolizumab Cuts COPD Exacerbations Across Smoking Status: Claus Vogelmeier, MD

The analysis stratified patients by smoking status and by blood eosinophil count (BEC) at screening (≥150 cells/µL or ≥300 cells/µL). Mepolizumab significantly reduced annualized moderate/severe exacerbations versus placebo in former smokers by 19% (BEC ≥150 cells/µL) and 25% (BEC ≥300 cells/µL), and in current smokers by 23% (BEC ≥150 cells/µL) and 18% (BEC ≥300 cells/µL, not statistically significant).¹ Former smokers also had significant reductions in exacerbations requiring emergency department visits or hospitalization and in severe exacerbations, while current smokers did not show significant reductions on either of those more serious outcomes.¹ Vogelmeier said this split reflects a real and clinically relevant distinction, but not one that should keep clinicians from treating active smokers who continue to exacerbate. 

How should these data inform treatment decisions?

"You have an active smoker that maybe has a history of severe exacerbations. You may start with the drug right away, although he's still actively smoking, but then you should try everything to get him away from the cigarettes," he said.

Mepolizumab is now the second biologic approved for COPD after dupilumab, and while comparable smoking-status data exist for dupilumab, Vogelmeier said the pooled nature of this analysis is itself a strength: because METREX, METREO, and MATINEE had somewhat heterogeneous inclusion criteria, combining them produced a broader, more clinically representative population than any single randomized trial typically captures. He said the data do not change his approach to initiating treatment in active smokers with a history of exacerbations, since the primary endpoint signal held even in that group, but they do reinforce that the expected effect size on the most serious outcomes is smaller until a patient stops smoking. GSK funded the trials.¹

Vogelmeier’s disclosures include AstraZeneca, CSL Behring, GSK, Hoffman – La Roche, Insmed, Sanofi, Boehringer Ingelheim, Novartis, and more.

Vogelmeier C, Wald J, Anzueto A, et al. Mepolizumab reduces moderate or severe exacerbations in patients with COPD irrespective of baseline smoking status: pooled Phase III trial results. Presented at: European Respiratory Society (ERS) Congress 2026; September 5-9, 2026; Barcelona, Spain.

Sciurba FC, Criner GJ, Christenson SA, et al. Mepolizumab to prevent exacerbations of COPD with an eosinophilic phenotype. 

. 2025;392(17):1710-1720. doi:10.1056/NEJMoa2413181

Videos

Vogelmeier, of Philipps-University of Marburg discusses pooled data showing reduced COPD exacerbations, though most effectively in former smokers.

Vogelmeier discusses major changes to the annual COPD report, including a broader threshold for escalating treatment after exacerbation.

Breaking Down the 2026 GOLD Report, with Claus Vogelmeier, MD

The Global Initiative for Obstructive Lung Disease (GOLD) released its 

 earlier this week, adding more than 300 relevant references from clinical research to the organization’s annually updated guidance on the definition, diagnosis, assessment, prevention, and management of 

This year’s report made several significant alterations to the clinical definitions that comprise COPD, including the shift to constitute any patient who has experienced ≥1 moderate or severe exacerbation in the last year to be classified as “exacerbated.” Previously, patients were required to have ≥2 exacerbations to reach this mark. This update was based on observational research showing that just 1 exacerbation prior to initiating maintenance pharmacotherapy could increase the risk of subsequent events — thereby warranting that clinicians consider treatment escalation at the threshold of 1 exacerbation in order to achieve low disease acidity state.

"If we are able to identify patients earlier in a state where not most of the lung is destroyed, and then select the right patient based on their endotype and give them the drugs that are targeted to this endotype...then we have a very high likelihood that we are able to change the natural cause the disease, and that that was not possible 20-30 years ago. We didn't have the management strategies, we didn't have the assessment strategies, we weren't able to diagnose earlier. I think this is the time to try."

The 2026 report additionally provided recommendations for goal-setting, monitoring, and prescribing / maintaining therapy for “stable COPD” — a previously less-defined state of disease without worsening markers nor symptoms.

Further, the report introduced the role of artificial intelligence (AI) in COPD detection, management, and research — setting the groundwork for further organization-level recommendations surrounding large language models (LLMs) and other AI tools to optimize COPD care.

 in Philadelphia, PA, this week, Claus Vogelmeier, MD, a professor at the University of Marburg and chair of the GOLD science committee, discussed the biggest updates to the annual report and what it means for the current and future priorities in COPD care progression.

Regarding the updated exacerbation classification, Vogelmeier noted the change does not affect initial COPD treatment — patients will still likely be initiated on long-acting beta agonist (LABA) plus an anticholinergic. But it will implicate future treatment, as it qualifies patients immediately for care escalation.

“We have learned over time that having an exacerbation, even moderate ones, can be very risky for the patients,” Vogelmeier said. “They may go to the hospital, they may need to be treated with steroids and/or antibiotics, they may lose lung function, they may lose quality of life. So with this as a background, we decided that we have to change the system.”

Vogelmeier explained that increasingly robust data on the clinical efficacy and safety of newer therapies to treat COPD, including triple-therapy inhaler devices and the recently approved biologic mepolizumab, gives him and the committee assurance that treatment escalation is worthwhile for patients after their first COPD exacerbation.

Regarding the addition of a second biologic to the annual GOLD report — following dupilumab — Vogelmeier acknowledged that more biomarkers need to become established in COPD, in order to reflect the metrics of treatment success with modern therapy.

“Most of the treatment decisions that we make are based on clinical parameters,” Vogelmeier said. “We have to move on to biological parameters, so we have to go from phenotype to endotype.”

The concept of “disease stability,” added to the GOLD report, reflects the increasing opportunity to reduce COPD activity in patients with the wider armamentarium of treatments now available.

“There are now the first data suggesting when patients are stable over certain periods of time, their prognosis will get better,” Vogelmeier said. “And this is not only good as an end point for future studies, that we try to have a composite endpoint that tells us about disease stability or control — but in addition to that, it also tells us how we can communicate better with patients. If they are doing well, we should tell them. And as you know, wording is extremely important.”

Global Initiative for Chronic Obstructive Lung Disease. 2026 GOLD Report and Pocket Guide. Web page. Accessed November 14, 2025. https://goldcopd.org/2026-gold-report-and-pocket-guide/

Johnson V. FDA Approves Mepolizumab for Eosinophilic COPD. 

. Published online May 22, 2025. https://www.hcplive.com/view/fda-approves-mepolizumab-for-eosinophilic-copd

Claus Vogelmeier, MD

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