Biologic cuts steroid exposure in COPD

Clinical takeaway: Consider mepolizumab as an add-on option for appropriate patients with eosinophilic COPD who continue to experience exacerbations despite inhaled triple therapy. New pooled phase 3 data suggest it may help reduce systemic corticosteroid exposure, potentially lowering the burden of steroid-related complications.

Systemic corticosteroids (SCS) remain a cornerstone of COPD exacerbation management but can contribute to substantial cumulative toxicity, particularly with repeated high-dose courses. As biologic therapies gain a role in type 2 inflammatory COPD, reducing steroid exposure is emerging as an important treatment goal alongside preventing exacerbations.

Findings presented at CHEST 2026, which have not yet undergone peer review, pooled data from the phase 3 METREX, METREO, and MATINEE trials to evaluate SCS use among 2,089 patients with COPD receiving inhaled triple therapy. Participants were randomized to mepolizumab 100 mg subcutaneously every 4 weeks or placebo for up to 104 weeks.

Investigators focused on patients with elevated blood eosinophil counts, a population most likely to benefit from IL-5 inhibition. Among patients with eosinophil counts ≥150 cells/μL, mean annual SCS exposure was about 435 mg of prednisolone equivalent with mepolizumab versus 610 mg with placebo, representing roughly 29% lower exposure. In those with eosinophil counts ≥300 cells/μL, annual exposure was approximately 354 mg versus 552 mg, a reduction of about 36%.

The benefit appeared to be driven largely by fewer high-dose corticosteroid treatment days. Patients receiving mepolizumab spent a greater proportion of follow-up time free from SCS and generally required fewer high-dose courses than those receiving placebo.

More than half of patients in both eosinophil strata received SCS during the trials, underscoring the ongoing treatment burden in this population despite optimized inhaled therapy.

“Mepolizumab can serve as an add-on to inhaled triple therapy and may reduce SCS burden in COPD, particularly complications associated with short-term high-dose courses, across a wide spectrum of screening blood eosinophil count levels,” said lead author Nicola Hanania, MD, MS, FCCP.

Source: Hanania NA, et al. (2026 Oct) CHEST 2026. Mepolizumab Reduces Systemic Corticosteroid Utilization in COPD With Type 2 Inflammation: Pooled Results From Phase 3 Randomized Trials