Mepolizumab for the prevention of chronic obstructive pulmonary disease exacerbations

Worldwide chronic obstructive pulmonary disease (COPD) is the third most common cause of non-communicable deaths. The pathobiology of the disease is predominantly neutrophilic but there is a subset of patients with elevated peripheral eosinophil count that respond better to inhaled and systemic corticosteroids currently being classified as eosinophilic phenotype. This review focuses on the role of mepolizumab, a fully humanized monoclonal antibody against IL-5 molecule that regulates the eosinophil life cycle, in the management of patients with this phenotype of COPD. Areas covered: A comprehensive appraisal of the existing literature about the pharmacokinetics/pharmacodynamics as well as the clinical efficacy, safety and side effects of mepolizumab in the management of COPD patients with high peripheral eosinophil count. Expert commentary: The use of monoclonal antibodies against IL-5 to decrease the eosinophil proliferation and subsequent airway inflammation is a promising therapeutic target for this phenotype of COPD patients. The current phase three trials showed a moderate effect on the decrease of annual rate of exacerbations significant in only one study. Further research is needed to specifically define the eosinophilic phenotype in the patients with COPD and the clinical efficacy of treatments designed as targeted therapy in patients with that characteristic profile.