Mepolizumab preserves lung function for up to 2 years in eosinophilic COPD

Mepolizumab treatment significantly improved pre-bronchodilator forced expiratory volume in 1 second (FEV1) compared with placebo in patients with eosinophilic chronic obstructive pulmonary disease (COPD), with a particularly pronounced effect among patients with global initiative for chronic obstructive lung disease (GOLD) stage 2. 

The MATINEE trial (NCT04133909) is a randomised, placebo-controlled phase 3 trial including participants aged ≥40 years with a confirmed diagnosis of eosinophilic COPD and no concurrent asthma. Participants received triple background therapy comprising inhaled corticosteroids, long-acting muscarinic agents, and long-acting beta-agonists, and were randomised to mepolizumab 100 mg every 4 weeks or placebo for 52 to 104 weeks [1]. Prof. Dave Singh (University of Manchester, UK) reported results from a post-hoc analysis examining pre-bronchodilator FEV1 from baseline to week 104, which included 804 participants in MATINEE [2].

Mepolizumab resulted in sustained FEV1 improvements over 104 weeks versus placebo. Among participants with GOLD stage 2, the placebo-adjusted FEV1 change from baseline was +72.8 mL (95% CI -24.5 to 170.1) at week 104, while the placebo-adjusted FEV1 change from baseline was +1.6 mL (95% CI -131.3 to 124.5) and +97.6mL (95% CI -75.7 to 270.6) for participants with GOLD stages 3 and 4, respectively. In participants with GOLD stage 2, there was a sharp decline in mean FEV1 with placebo, while mean FEV1 remained stable with mepolizumab.

In summary, mepolizumab maintained or improved lung function through week 104, with the largest relative benefit in patients with GOLD grade 2, those typically at risk of faster lung function decline.

1. Sciurba FC, et al. N Engl J Med. 2025;392(17):1710-1720.
2. Singh D, et al. Sustained FEV1 improvements with mepolizumab up to 104 weeks in patients with COPD and less severe airflow obstruction: Post hoc analysis of the MATINEE Phase III study. ERS Congress, 27 September–1 October 2025, Amsterdam, the Netherlands.

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Posted on 30 October 2025