A pooled analysis of Phase 3 clinical trials shows mepolizumab cuts annual steroid exposure and high-dose treatment days for COPD patients.


RT’s Three Key Takeaways:

  1. Reduced Steroid Exposure: A pooled analysis of three Phase 3 clinical trials demonstrated that mepolizumab significantly decreased total yearly systemic corticosteroid exposure in patients with COPD and type 2 inflammation.
  2. Fewer High-Dose Days: Patients treated with mepolizumab spent fewer days receiving high-dose steroid courses compared with those receiving a placebo.
  3. Broad Efficacy: The reductions in steroid burden occurred across multiple baseline blood eosinophil count levels in patients already receiving inhaled triple therapy, according to study findings.


Mepolizumab (Nucala) reduced total yearly systemic corticosteroid exposure, particularly high-dose courses, among patients with COPD and type 2 inflammation who were receiving inhaled triple therapy, according to data presented at Chest 2026.

Clinical treatment guidelines recommend SCS for COPD exacerbations; however, these medications are associated with complications in patients with COPD, underscoring a need for targeted treatments capable of lowering SCS burden, researchers noted. Mepolizumab is a humanized monoclonal antibody that targets interleukin-5 and is approved as an add-on maintenance therapy in patients with COPD and an eosinophilic phenotype.

To evaluate treatment impact, investigators conducted a pooled analysis of data from three Phase 3, randomized, placebo-controlled clinical trials: METREX, METREO, and MATINEE. Eligible patients were aged 40 years or older, had a COPD diagnosis for at least one year, were receiving inhaled triple therapy, had a history of exacerbations, and had no current diagnosis of asthma. Trial participants received either mepolizumab 100 mg subcutaneously or placebo every four weeks.

The study examined the percentage of days receiving SCS and total SCS exposure for any cause among 2,089 enrolled patients, according to the analysis. Of those enrolled, 1,713 patients had blood eosinophil counts (BEC) of at least 150 cells/µL, and 1,144 patients had BEC of at least 300 cells/µL.

For patients with BEC of 150 cells/µL or greater, mean total SCS exposure was 434.64 mg/year with mepolizumab compared with 609.95 mg/year with placebo, according to the reported data. Among patients with BEC of 300 cells/µL or greater, mean total exposure was 354.28 mg/year with mepolizumab compared with 551.52 mg/year with placebo. Investigators also observed that mepolizumab-treated patients spent fewer days receiving high-dose SCS compared with patients receiving placebo.

“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 BEC levels,” said Nicola Hanania, MD, MS, FCCP, lead author and Chest 2026 presenter.

Reference: “Mepolizumab Reduces Systemic Corticosteroid Utilization in COPD With Type 2 Inflammation: Pooled Results From Phase 3 Randomized Trials.”