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Managing COPD Exacerbations with Mepolizumab: A New Era in Biologic Therapy

mepolizumab copd exacerbations
06/23/2025

Managing COPD exacerbations has long posed a significant challenge—now, with mepolizumab’s FDA approval as an add-on therapy for patients prone to acute exacerbations, clinicians have a novel biologic tool to aid in the reduction in annual exacerbation rates.

Chronic obstructive pulmonary disease remains marked by recurrent exacerbations despite optimized bronchodilator regimens and inhaled corticosteroids. Mepolizumab's recent FDA approval for COPD exacerbations offers a new therapeutic pathway, particularly among patients with elevated eosinophil counts who continue to experience frequent exacerbations. According to the GOLD COPD strategy, biologics like mepolizumab are recommended for specific phenotypes.

Evidence for this strategy stems from the MATINEE and METREX phase III trials, which showed significant reductions in annual exacerbation rates, with relative reductions of around 20% and p-value <0.05, among those with eosinophilic COPD phenotypes. This aligns with data previously presented, underscoring mepolizumab treatment as a step toward targeted intervention beyond standard therapies.

Beyond eosinophil-directed approaches, type 2 inflammation has emerged as another treatable endotype in COPD. Recent findings indicate that dupilumab reduces exacerbations in patients with type 2-driven COPD. However, its use is currently investigational with ongoing phase II trials assessing its efficacy.

Earlier reports noted that depemokimab’s Biologics License Application was accepted by the FDA for severe asthma, which may indicate further potential applications in COPD. This pattern of advancing biologics invites exploration into new pathways for patient subsets unresponsive to current regimens.

As biologics reshape the treatment horizon, pulmonologists and primary care providers should consider eosinophil counts and type 2 biomarkers when evaluating eligibility, while remaining vigilant for long-term safety and cost-effectiveness data. Ongoing surveillance and real-world registries will be crucial to define which patient subsets derive the greatest benefit from these novel agents.

Key Takeaways:
  • Mepolizumab offers a new therapeutic option for reducing COPD exacerbations.
  • Support from the MATINEE and METREX trials underlines its clinical efficacy.
  • Dupilumab is a promising choice for COPD patients with type 2 inflammation.
  • Biologics may lead the future of COPD management, pending further research.
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