Chest · 2026
Mepolizumab and Dupilumab Show No Significant Difference in Reducing Exacerbations in Patients With COPD and an Eosinophilic Phenotype: Matching-Adjusted Indirect Treatment Comparison.
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Bourbeau Jean, Min Jeff, Kolterer Stefanie, Yang Shibing, Hunger Matthias, Wang Xuan, Sciurba Frank C
Аннотация
BACKGROUND: Mepolizumab and dupilumab are monoclonal antibodies targeting type 2 inflammation that are both approved as add-on maintenance treatment in patients with inadequately controlled COPD and an eosinophilic phenotype.
RESEARCH QUESTION: What is the comparative efficacy of mepolizumab and dupilumab in reducing the risk of exacerbations and improving health-related quality of life in patients with COPD and an eosinophilic phenotype?
STUDY DESIGN AND METHODS: This study used a robust matching-adjusted indirect comparison (MAIC) approach to compare pooled efficacy data from 3 phase 3 randomized, placebo-controlled COPD trials of mepolizumab (METREX, METREO, and MATINEE) with 2 trials of dupilumab (BOREAS and NOTUS). An indirect comparison was performed using MAIC, reweighting individual patient data from mepolizumab trials using propensity score-based methods to match the aggregate baseline characteristics of the dupilumab trial populations. To match the more restrictive eligibility criteria of the dupilumab trials, patients from the mepolizumab studies were included in this MAIC if they showed blood eosinophil counts of ≥ 300 cells/μL at screening, modified Medical Research Council scale dyspnea grade ≥ 2, moderate-to-severe airflow limitation, and chronic bronchitis (CB; defined by investigator assessment or St. George's Respiratory Questionnaire for COPD [SGRQ-C]). Outcomes included rate or risk of exacerbations and health-related quality of life (SGRQ-C).
RESULTS: No statistically significant differences were observed in the reduction of the annualized rate of moderate to severe exacerbations (rate ratio, 0.91 [95% CI, 0.60-1.37] using investigator-assessed CB and 1.13 [95% CI, 0.80-1.58] using the SGRQ-C CB definition). No statistically significant differences were observed in SGRQ-C changes.
INTERPRETATION: Our results from this MAIC study showed no statistically significant differences between mepolizumab and dupilumab in the magnitude of effect in reducing moderate to severe exacerbations and improving health-related quality-of-life outcomes.
RESEARCH QUESTION: What is the comparative efficacy of mepolizumab and dupilumab in reducing the risk of exacerbations and improving health-related quality of life in patients with COPD and an eosinophilic phenotype?
STUDY DESIGN AND METHODS: This study used a robust matching-adjusted indirect comparison (MAIC) approach to compare pooled efficacy data from 3 phase 3 randomized, placebo-controlled COPD trials of mepolizumab (METREX, METREO, and MATINEE) with 2 trials of dupilumab (BOREAS and NOTUS). An indirect comparison was performed using MAIC, reweighting individual patient data from mepolizumab trials using propensity score-based methods to match the aggregate baseline characteristics of the dupilumab trial populations. To match the more restrictive eligibility criteria of the dupilumab trials, patients from the mepolizumab studies were included in this MAIC if they showed blood eosinophil counts of ≥ 300 cells/μL at screening, modified Medical Research Council scale dyspnea grade ≥ 2, moderate-to-severe airflow limitation, and chronic bronchitis (CB; defined by investigator assessment or St. George's Respiratory Questionnaire for COPD [SGRQ-C]). Outcomes included rate or risk of exacerbations and health-related quality of life (SGRQ-C).
RESULTS: No statistically significant differences were observed in the reduction of the annualized rate of moderate to severe exacerbations (rate ratio, 0.91 [95% CI, 0.60-1.37] using investigator-assessed CB and 1.13 [95% CI, 0.80-1.58] using the SGRQ-C CB definition). No statistically significant differences were observed in SGRQ-C changes.
INTERPRETATION: Our results from this MAIC study showed no statistically significant differences between mepolizumab and dupilumab in the magnitude of effect in reducing moderate to severe exacerbations and improving health-related quality-of-life outcomes.