Mepolizumab Antibody Therapy to Help Treatment of Resistant COPD Patients

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Highlights:

• New study proves that an antibody based therapy using mepolizumab for this sub group of COPD patients drastically reduces their COPD attacks or flare-ups.
• Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease that blocks airflow to the lungs.
• While COPD is treatable, about 40% of these patients have a high eosinophilic count and are treatment resistive.
• These individuals have moderate or severe worsening of symptoms even while on treatment, which can be fatal in case of COPD.

COPD, Eosinophil Count and Flare-ups

About 40% of COPD patients have a high eosinophilic phenotype, which means that their eosinophil (a type of WBC that shoots up in number when their is infection) count in the blood is more than 2%.

Individuals with this phenotype are more at risk for developing exacerbations or flare-ups (worsening of symptoms). Flare-ups may be triggered due to bacteria or other environmental factors. It has to be promptly treated otherwise, it may result in greater complications.

‘Clinical trials show that antibody therapy using mepolizumab reduces flare-ups in COPD patients who are treatment-resistive and have high eosinophilic count.’

Patients with high levels of eosinophils, who are resistive to the standard treatment protocol which includes bronchodilators and glucocorticoids are susceptible to constant flare-ups.

"These patients already have been given every treatment we have to offer them and are still having flare-ups that significantly interfere with their quality of life and can lead to deterioration in lung function and higher mortality," said lead author Frank Sciurba, M.D. At the University of Pittsburgh School of Medicine. "We hoped to be able to offer them an option."

Antibody Therapy: A Precision Medicine

"The goal of precision medicine is to give the right treatment to the right patient," said Sciurba."These findings are the first example of a precision therapy that is uniquely effective in a subgroup of patients with treatment-resistant COPD."

The research team has analyzed the results of two phase III clinical trials that evaluated the efficacy of the antibody, mepolizumab. Mepolizumab reduces the number of eosinophils in the blood by blocking the pro-inflammatory effects of a chemical.

The very same antibody is already approved by the FDA to be used in reducing symptoms and improving quality of life in eosinophilic asthma patients.

The Clinical Trials

First Clinical Trial: METREX

Where and when? Conducted in 16 countries from 2014 to 2017.

How many participants? 837 COPD patients with varying eosinophil levels.

Dosage of antibody? Participants were randomly given 100mg of mepolizumab or placebo.

Study Findings

Patients with high eosinophil count and received the antibody had a 18% lower rate of moderate/severe flare-ups.

Second Clinical Trial: METREX

Where and when? Conducted in 15 countries from 2014 to 2017.

How many participants? 675 COPD patients with elevated eosinophil levels.

Dosage of antibody? Participants were randomly given either 100mg or 300mg of mepolizumab or placebo.

Study Findings

Similar to METREX, patients who received the antibody had a 20% lower rate of moderate/severe flare-ups.

Also, the higher dosage of 300mg of mepolizumab did not provide an advantage over the lower dose.

The analysis of data from both trials found that mepolizumab's efficacy in reducing the flare-ups increased with increased baseline eosinophil count. Thereby, patients with higher eosinophil levels benefited more from the antibody therapy than those with eosinophil counts.

What is COPD?

Chronic Obstructive Pulmonary Disease (COPD) is an inflammatory lung disease that causes obstructed airflow from the lungs. It is most often caused due to exposure to cigarette smoke. If one has COPD, usual shortness of breath could suddenly worsen into severe cough and increased mucus production. This is called a COPD flare-up. If not treated immediately, these flare-ups could become fatal. Some COPD patients who are already seeking treatment, do have increased rate of these flare-ups due to treatment resistance. Researchers at University of Pittsburg Medical School have found out that an antibody based therapy could potentially reduce the flare-ups for this subgroup of COPD patients. The study was published in the New England Journal of Medicine.

References:

1. Ian D. Pavord, D.M., Pascal Chanez, M.D., Ph.D., Gerard J. Criner, M.D., Huib A.M. Kerstjens, M.D., Ph.D., Stephanie Korn, M.D., Ph.D., Njira Lugogo, M.D., Jean-Benoit Martinot, M.D., Hironori Sagara, M.D., Ph.D., Frank C. Albers, M.D., Ph.D., Eric S. Bradford, M.D., Stephanie S. Harris, B.Sc., Bhabita Mayer, M.Sc., David B. Rubin, M.D., Steven W. Yancey, M.Sc., and Frank C. Sciurba, M.D., New England Journal Of Medicine, DOI: 10.1056/NEJMoa1708208
2. COPD - Treatment - (http://www.mayoclinic.org/diseases-conditions/copd/diagnosis-treatment/treatment/txc-20204923)

Source: Medindia

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