Add-On Mepolizumab Decreases Exacerbations in Eosinophilic COPD

Mepolizumab decreased moderate or severe exacerbations when added to background triple inhaled therapy in patients with chronic obstructive pulmonary disease (COPD) and an eosinophilic phenotype, full data from the phase 3 MATINEE trial show.1

“Every physician will know the feeling of seeing a patient hospitalized due to an exacerbation that could have possibly been prevented. The MATINEE trial uncovers new possibilities in the treatment landscape for COPD patients with type 2 inflammation, as we strive to target drivers of disease and improve the lives of patients suffering with COPD,” primary investigator Frank Sciurba, MD, Professor of Pulmonary, Allergy and Critical Care Medicine, said in a statement.2

MATINEE was a double-blind, randomized, placebo-controlled trial that enrolled 804 patients with COPD, a history of exacerbations, and a blood eosinophil count of at least 300 cells per microliter who were receiving triple inhaled therapy. The trial’s population included those with chronic bronchitis, emphysema only or both. The participants were randomized 1:1 to receive mepolizumab 100 mg (n = 403) or placebo (n = 401) subcutaneously every 4 weeks for 52 to 104 weeks. 1

The trial’s primary end point was the annualized rate of moderate or severe exacerbations while secondary end points included moderate or severe exacerbation as assessed in a time-to-first-event analysis, measures of health-related quality of life and symptoms, and the annualized rate of exacerbations leading to an emergency department visit, hospitalization, or both.

Sciurba and colleagues found that mepolizumab demonstrated a statistically significant and clinically meaningful 21% reduction in the annualized rate of moderate or severe exacerbations (0.80 events per year) compared to placebo (1.01 events per year; rate ratio, 0.79; 95% CI, 0.66 to 0.94; P = .01), successfully meeting the primary endpoint. Time to first moderate or severe exacerbation was also significantly prolonged with mepolizumab, with a median of 419 days compared to 321 days with placebo (hazard ratio, 0.77; 95% CI, 0.64 to 0.93; P = .009). However, no significant between-group differences were observed in health-related quality of life or symptom measures, and further secondary endpoints were not formally tested.1

Post-hoc analysis of a subgroup with clinician-assessed chronic bronchitis showed a 31% reduction in annualized exacerbation rates with mepolizumab (rate ratio, 0.69; 95% CI, 0.51 to 0.93; n = 338). Additionally, a 35% reduction in exacerbations leading to emergency department visits and/or hospitalization was observed, with an annualized event rate of 0.13 per year for mepolizumab versus 0.20 for placebo (rate ratio, 0.65; 95% CI, 0.43 to 0.96), which was nominally significant after adjustment for multiplicity.1

The mepolizumab group demonstrated high response rates in Patient Reported Outcomes (PROs) but no differences were observed for St George’s Respiratory Questionnaire (SGRQ), the COPD Assessment Test (CAT) and the Evaluating Respiratory Symptoms (E-RS) in the full study population versus placebo.

In terms of safety, the incidence of adverse events (AEs) was similar between mepolizumab (74%) and placebo groups (77%), with exacerbation or worsening of COPD being the most frequent AE (mepolizumab, 12%; placebo, 15%) and COVID-19 infection (both 12%).1

“Today’s MATINEE results show that mepolizumab can help prevent exacerbations, including those leading to emergency department visits and/or hospitalization. These exacerbations are devastating for patients, known to cause irreversible lung damage, worsening of symptoms and increased mortality. For decades, we have and will continue to push the boundaries of innovation to prevent disease progression and make a meaningful impact on the lives of people affected by COPD,” Kaivan Khavandi, SVP, Global Head, Respiratory, Immunology & Inflammation R&D, GlaxoSmithKline, added.2

Mepolizumab is a monoclonal antibody that targets interleukin-5 (IL-5). The therapy is under review for approval in countries including the United States (US), China, and European Union. In the US, mepolizumab has a PDUFA date of May 7, 2025 for potential approval under the name Nucala.2

REFERENCES

1. Sciruba FC, Criner GJ, Christenson SA, et al. Mepolizumab to Prevent Exacerbations of COPD with an Eosinophilic Phenotype. N Engl J Med. 2025;392:1710-1720. DOI: 10.1056/NEJMoa2413181

2. Nucala (mepolizumab) delivers clinically meaningful and statistically significant reduction in COPD exacerbations, with positive MATINEE trial results published in New England Journal of Medicine. News release. GlaxoSmithKline. April 30, 2025. https://www.gsk.com/en-gb/media/press-releases/nucala-mepolizumab-delivers-clinically-meaningful-and-statistically-significant-reduction-in-copd-exacerbations-with-positive-matinee-trial-results-published-in-nejm/