Mepolizumab for Eosinophilic Chronic Obstructive Pulmonary Disease

Applications for Clinical Practice

In this study, Pavord and colleagues found a potential benefit of mepolizumab treatment for reducing exacerbations in COPD patients with an eosinophilic phenotype. The conflicting results regarding the underlying physiology and the weak treatment effect suggest this medication may not be ready for use in clinical practice without additional supporting evidence. From a practical standpoint, the high cost of medication (~$2500 per month) and marginal benefit of treatment imply that treatment with mepolizumab in COPD patients may not be cost-effective, and even treatment in individual patients on a trial basis should be discouraged until additional supporting data becomes available. Of primary concern are the optimal selection of COPD patients that will achieve benefit with mepolizumab treatment, and the optimal dose of medication to achieve that benefit. The results presented here do not satisfactorily answer these questions, and additional studies are required.

—Arun Jose, MD, The George Washington University, Washington, DC