Mepolizumab for severe eosinophilic asthma

INTRODUCTION: Severe eosinophilic asthma is a distinct asthma phenotype that is characterized by elevated blood eosinophils, frequent exacerbations and dependence on treatment with systemic corticosteroids. The development of Mepolizumab, a monoclonal antibody that targets Interleukin 5, has significantly transformed the therapeutic approach of patients with severe eosinophilic asthma. AREAS COVERED: This review explores the clinical development, efficacy, effectiveness and safety profile of mepolizumab. It also discusses emerging evidence on mepolizumab's role in achieving clinical remission and modifying airway remodeling. A literature search was conducted using PubMed database for articles published before June 2025, including randomized controlled trials, observational studies, and mechanistic investigations. EXPERT OPINION: Personalized medicine is an emerging field in treatment of severe eosinophilic asthma with the development of biologic agents. Mepolizumab has shown significant benefits in patients with severe eosinophilic asthma (reducing asthma exacerbations, improving quality of life and lung function), while remission has emerged as a treatment goal in some patients. The impact of mepolizumab in airway remodeling suggests its use as a disease modifying therapy not just as a symptom controller.