PT  - JOURNAL ARTICLE
AU  - Angira Dasgupta
AU  - Melanie Kjarsgaard
AU  - Dante Capaldi
AU  - Katherine Radford
AU  - Fernando Aleman
AU  - Grace Parraga
AU  - Len Altman
AU  - Thomas Wight
AU  - Paul M. O'Byrne
AU  - Parameswaran Nair
TI  - Mepolizumab in COPD with eosinophilic bronchitis: A randomized clinical trial
AID  - 10.1183/13993003.congress-2016.PA305
DP  - 2016 Sep 01
TA  - European Respiratory Journal
PG  - PA305
VI  - 48
IP  - suppl 60
4099  - http://erj.ersjournals.com/content/48/suppl_60/PA305.short
4100  - http://erj.ersjournals.com/content/48/suppl_60/PA305.full
SO  - Eur Respir J2016 Sep 01; 48
AB  - Background: Chronic obstructive pulmonary disease (COPD) has associated eosinophilic bronchitis in 10–20% patients. Mepolizumab, an anti-interleukin-5 antibody, depletes blood eosinophils, sputum eosinophils and reduces asthma exacerbations.Aim: We aimed to find out if mepolizumab had similar effects in COPD with sputum eosinophilia.Methods: In this double-blind, placebo-controlled, randomized study patients (40–80 years) with moderate-to-severe COPD (post-bronchodilator FEV1/VC<70%; post-bronchodilator FEV1<60% predicted) and current/ex-smokers (>10 pack-years) with sputum eosinophilia (≥3%),who had previously shown at least 100 ml improvement in FEV1 to a short course of prednisone, received monthly mepolizumab injections 750 mg or placebo for 6 monthsResults: 18 patients were randomised (8 in active-arm,10 in placebo).Mepolizumab reduced sputum eosinophils (baseline 11% to 0.5% at 6 months in active arm vs 7.35% to 2.2% in placebo arm, p<0.05) and blood eosinophils (0.69 at baseline to 0.03 at 6 months in active-arm vs 0.33 to 0.26 in placebo-arm, p<0.05). There were no significant changes with treatment in the secondary outcomes: lung function (FEV1, FVC, SVC, FEV1/SVC, FEV1/FVC, TLC, RV, RV/TLC and DLCO), exacerbation rates, patient-related outcomes, sputum markers (hyaluron and versican) and CT assessments of remodelling (airway-wall,lumen area,parametric response maps or relative areas of the CT density-histograms).Conclusion: Mepolizumab did not improve lung function and exacerbation rates in COPD with eosinophilia. This suggests that although eosinophils are a predictor of response to treatment with corticosteroids, unlike in asthma, they may not directly contribute to luminal obstruction in COPD.