Mepolizumab Following Hospitalisation for Severe Exacerbation of Eosinophilic COPD

Résumé fourni par la source

Hospitalisation for acute exacerbation of COPD (AECOPD) is associated with readmission and death. Some patients with COPD have type 2 inflammation, indicated by increased blood eosinophils, for which biologic treatment has shown to reduce moderate AECOPD. Mepolizumab, a monoclonal antibody to IL-5, reduces eosinophilic inflammation in COPD while effects on hospitalisation and mortality are uncertain. COPD-HELP was a single-centre, phase IIb, double-blind, placebo-controlled study randomising patients hospitalised with AECOPD to mepolizumab 100mg or placebo 4-weekly for 48 weeks. Participants (≥40 years) had a blood eosinophil count of at least 300 cells/ul within the prior 12 months and were established on inhaled corticosteroids. The primary end point was time to readmission or death (any cause). Secondary endpoints included number of readmissions and number of moderate or severe exacerbations. 238 patients were randomised. Median time to rehospitalisation or death was 25.4 and 26.1 weeks with mepolizumab and placebo respectively (KM estimates of 33.9% and 31.0% (HR 0.96 (95%CI 0.7 to 1.32, p=0.811)). The adjusted mean (95% CI) number of hospital readmissions over 48 weeks was 1.65(1.25-2.05) and 1.85(1.42-2.29) respectively (RR[95% CI] 0.89 [0.64-1.25]). The adjusted mean (95% CI) number of moderate or severe exacerbations over 48 weeks was 2.80 (2.36-3.23) and 3.45 (2.94-3.95) respectively (RR[95% CI] 0.81 [95% CI 0.66-1.00]). Patients hospitalised with AECOPD and evidence of eosinophilic inflammation had no benefit in risk of rehospitalisation or death when given mepolizumab for 48 weeks. A numerical reduction similar to other trials in the number of moderate and severe exacerbations was observed.

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