Anti‐IL‐5 therapies for chronic obstructive pulmonary disease

Anti‐IL‐5 therapies for chronic obstructive pulmonary disease

This review aimed to assess the efficacy and safety of monoclonal antibody therapies targeting IL‐5 signalling (anti‐IL‐5 or anti‐IL‐5Rα) compared with placebo in the treatment of adults with COPD. The review used standard Cochrane methods.

Exacerbations of chronic obstructive pulmonary disease (COPD) are a major cause of hospital admissions, disease‐related morbidity and mortality. COPD is a heterogeneous disease with distinct inflammatory phenotypes, including eosinophilia, which may drive acute exacerbations in a subgroup of patients. Monoclonal antibodies targeting interleukin 5 (IL‐5) or its receptor (IL‐5R) have a role in the care of people with severe eosinophilic asthma, and may similarly provide therapeutic benefit for people with COPD of eosinophilic phenotype.

The review included 6 studies involving 5542 participants. Three studies used mepolizumab (1530 participants), and three used benralizumab (4012 participants). The studies were on people with COPD, which was similarly defined with a documented history of COPD for at least one year. We deemed the risk of bias to be generally low, with all studies contributing data of robust methodology.

We found that:

  • Mepolizumab and benralizumab probably reduce the rate of moderate and severe exacerbations in the highly selected group of people who have both COPD and higher levels of blood eosinophils
  • There was probably little or no difference between the intervention and placebo for quality of life measures.
  • Treatment with mepolizumab and benralizumab appeared to be safe. All pooled analyses showed that there was probably little or no difference in serious adverse events, adverse events, or side effects between the use of a monoclonal antibody therapy compared to placebo.

Iain Crossingham, an author of the review, said “The interesting bit for me in all of this is that the same mistakes that were made 15 years ago with IL-5 drugs in asthma have been made again in COPD. The drug manufacturers have tried to show a modest benefit in all comers,  rather than going for a big effect in a highly selected group. What we need is a trial of IL-5 drugs in people with fixed airflow obstruction or radiologically evident emphysema with frequent exacerbations and peripheral blood eosinophilia despite taking high dose inhaled steroid.”

Read the full review here.
This summary is based on the abstract and was prepared by Emma Dennett.