A34-14 Mepolizumab vs Placebo in Eosinophilic Chronic Obstructive Pulmonary Disease: Meta-Analysis of Randomized Controlled Trials

Abstract Rationale Eosinophilic airway inflammation is present in 20–40% of patients with chronic obstructive pulmonary disease (COPD). Recent trials suggest promising results of mepolizumab in patients with eosinophilic COPD. Objective To evaluate efficacy and safety of mepolizumab in patients with eosinophilic COPD. Methods We systematically searched Cochrane, PubMed, and Embase from inception to June 2025 for randomized controlled trials (RCTs) comparing mepolizumab versus placebo in patients with eosinophilic COPD. Risk ratios (RR), rate ratio (IRR), mean differences (MD), and hazard ratios (HR) with 95% confidence intervals (CI) were pooled using a random-effects meta-analysis. Individual patient data (IPD) were estimated from Kaplan-Meier (KM) curves. Statistical analyses were performed using R version 4.5.0 (R Foundation for Statistical Computing). Results We included four RCTs, encompassing 1,945 patients (mean age range 65.0–69.1 years; 49–69% male), of whom 768 (39.5%) received mepolizumab 100 mg subcutaneously every 4 weeks and 1,177 (60.5%) received placebo. Compared with placebo, mepolizumab significantly reduced the rate of moderate-to-severe exacerbations (IRR 0.80; 95% CI 0.73–0.89; p < 0.01; I² = 0%). IPD-KM showed no difference for time to first moderate-to-severe exacerbation (HR 0.93; 95% CI 0.83 to 1.03), yet landmark analysis revealed differences during the first 26 weeks favoring mepolizumab (HR 0.78; 95% CI 0.67 to 0.90). We found no significant differences between treatment arms COPD Assessment Test score (MD − 0.28 points; 95% CI − 1.05 to 0.49), St. George’s Respiratory Questionnaire score (MD − 1.12 points; 95% CI − 2.53 to 0.30), emergency department visits/hospitalizations (RR 0.81; 95% CI 0.61–1.08), and all-cause mortality (RR 0.76; 95% CI 0.44 to 1.29). Mepolizumab demonstrated a safe profile, with no difference in the risk of any adverse event compared with placebo. Conclusion Patients with eosinophilic COPD taking mepolizumab showed a mild reduction in moderate-to-severe exacerbation rate, yet no delay in the first episode of exacerbation. We found no benefit of mepolizumab for symptoms, quality of life, or mortality. This abstract is funded by: None