Mepolizumab Reduced COPD Exacerbations, With Gerard Criner, MD

Mepolizumab reduced exacerbations requiring emergency department visits or hospitalization among patients with eosinophilic chronic obstructive pulmonary disease (COPD) receiving inhaled triple therapy, according to pooled phase 3 findings presented at the 2026 American Thoracic Society (ATS) International Conference in Orlando, Florida.1

In an interview at ATS 2026, Gerard Criner, MD, from the Lewis Katz School of Medicine at Temple University, said the integrated analysis demonstrated clinically meaningful benefit across a broader range of eosinophilic COPD phenotypes than many clinicians may currently recognize. Patients with blood eosinophil counts ≥ 150 can have clinical benefit from mepolizumab.

The pooled analysis combined results from the phase 3 METREX, METREO, and MATINEE trials, evaluating mepolizumab 100 mg added to inhaled triple therapy in patients with COPD and eosinophilic inflammation.2 Across the studies, investigators analyzed outcomes among patients with blood eosinophil counts (BEC) ≥ 150 cells/µL at screening and/or ≥ 300 cells/µL in the prior year.1

Among 1713 patients meeting eosinophilic criteria, mepolizumab significantly reduced the annualized rate of exacerbations requiring emergency department visits and/or hospitalization by 23% versus placebo (rate ratio, 0.77; 95% CI, 0.60-0.99; P =.044). The therapy also reduced the hazard of a first such exacerbation by 22% through week 104 (hazard ratio, 0.78; 95% CI, 0.62-0.97; P = .029). Investigators additionally observed a trend toward reduced severe exacerbations requiring hospitalization or resulting in death.1

Criner emphasized that the findings reinforce the importance of recognizing type 2 inflammation in COPD and suggest that clinically relevant benefit may extend to patients with eosinophil counts beginning at 150 cells/µL.

“It shows the range of patients that have type 2 inflammation can exist at 150 and greater,” Criner said. “It means clinicians… should measure the blood eosinophil count more than once to identify a patient that… might benefit from mepolizumab.”

He noted that while some patients may not perceive substantial symptomatic improvement, prevention of hospitalization and exacerbation burden may still provide meaningful clinical benefit. Criner also highlighted the safety findings from the pooled analysis, particularly given the advanced age and comorbidity burden common in COPD populations.

Criner said decisions regarding biologic initiation in COPD should involve individualized assessment and shared decision-making discussions between clinicians and patients.

“You’re going to have to really assess the patient… and know why you’re using a biologic for them,” he said. “Is it exacerbation reduction alone? Is it trying to improve quality of life? Or is it both?”

Editor’s note: Relevant disclosures for Criner include Pulmonx Corporation, GENZYME CORPORATION, GlaxoSmithKline, Olympus Corporation of the Americas, F. Hoffmann-La Roche AG, and AstraZeneca Pharmaceuticals.

References

1. Criner G, Watz H, Schamroth J, et al. (Poster Board # P1496) Mepolizumab Reduces the Burden of Chronic Obstructive Pulmonary Disease Exacerbations in a Wide Spectrum of Patients: Pooled Results From Phase III Randomized Controlled Trials. Poster presented at ATS 2026 in Orlando, Florida, on May 17.

2. Johnson V. Mepolizumab Reduces Type 2 COPD Exacerbations Across Variable BEC Levels. HCPLive. Published on February 28, 2026. Accessed May 19, 2026. https://www.hcplive.com/view/mepolizumab-reduces-type-2-copd-exacerbations-across-variable-bec-levels