Mepolizumab reduced all tested measures of systemic corticosteroid (SCS) use for any cause, as well as in response to acute exacerbation of COPD (AECOPD), compared to placebo, in a post hoc analysis of data from the randomized, parallel-group phase 3 MATINEE trial.
As an add-on to background inhaled triple therapy, mepolizumab, a humanized monoclonal antibody that specifically targets interleukin-5, is known to improve exacerbation outcomes, and it may also reduce SCS burden in patients with COPD.
Systemic corticosteroid (SCS) use is associated with poor outcomes in patients with COPD, so effective targeted treatments to reduce SCS use in this context are needed.
The 804 patients enrolled in the double-blind MATINEE trial were 40 years of age or older and had COPD and blood eosinophil counts of at least 300 cells/µL at baseline. They also had a history of exacerbations, even though they received background inhaled triple therapy (dual long-acting bronchodilators plus inhaled corticosteroid (at least 500 μg/day of fluticasone propionate or equivalent).
Of these, 403 participants received subcutaneous mepolizumab 100 mg every 4 weeks for 52 to 104 weeks, and 401 received placebo added to their background therapy. Overall, 423 participants received SCSs for any cause, and 390 received the drugs for AECOPD.
Less Time Taking SCSs
Patients in the mepolizumab group did not receive SCS for a mean of 92.3% of days, compared with 89.9% in the placebo group. Patients in the treatment group did not receive AECOPD-related SCS for a mean of 95.7% of days, compared with 94.2% in the placebo group.
Patients who received mepolizumab had a mean percentage of days receiving SCS for any cause of 4.6% on low dose and 3.1% on high dose, compared with 5.3% and 4.8%, respectively, among patients who received placebo. Participants on low dose of mepolizumab received AECOPD-related SCS for 1.2% of days on low dose and 3.1% on high dose compared to 1.3% and 4.5, respectively, for participants in the placebo group.
The researchers converted all SCS doses to prednisolone equivalents measured in mg/day and categorized them as low (less than 20 mg/day) or high (at least 20 mg/day) doses.
The mean total exposure to SCS due to any cause was 0.76 mg/day with mepolizumab vs 1.29 mg/day with placebo (41% relative difference vs placebo; mean difference 0.53 mg/day). The total exposure for AECOPD-related SCS was 0.60 mg/day with mepolizumab vs 1.00 mg/day with placebo (40% relative difference vs placebo; mean difference 0.41 mg/day).
Reference
Hanania NA, Burrows E, Emmerson J, et al. Mepolizumab Reduces Systemic Corticosteroid Utilization in Chronic Obstructive Pulmonary Disease: Post-hoc Analysis of the Phase III MATINEE Study. Presented at: CHEST 2025, October 19-22, 2025; Chicago.
