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Mepolizumab and dupilumab show no significant difference in reducing exacerbations in COPD patients with eosinophilic phenotype

A matching-adjusted indirect comparison (MAIC) of three mepolizumab trials (METREX, METREO, MATINEE) and two dupilumab trials (BOREAS, NOTUS) found no statistically significant differences between the two biologics in reducing moderate/severe exacerbations or improving health-related quality of life (SGRQ-C) in COPD patients with eosinophilic phenotype. The rate ratio for annualized moderate/severe exacerbations was 0.91 (95% CI: 0.60-1.37) using investigator-assessed chronic bronchitis and 1.13 (95% CI: 0.80-1.58) using SGRQ-C definition, both non-significant.

Last updated: Aug 22, 2026•0 RCTs•1 Meta-analyses•📖 Read as article →

Evidence Score

Evidence Score53/100
Human RCT☆☆☆☆☆
Meta-analysis★★★☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Mepolizumab and Dupilumab Show No Significant Difference in Reducing Exacerbations in Patients with COPD and an Eosinophilic Phenotype: Matching-Adjusted Indirect Treatment Comparison.

observational

Bourbeau J, Min J, Kolterer S, Yang S, Hunger M, Wang X, Sciurba FC · Chest (2026)

Participants: N/A
Duration: N/A
Intervention: Mepolizumab compared to dupilumab via matching-adjusted indirect comparison
Outcome: Annualized rate of moderate/severe exacerbations and change in SGRQ-C (health-related quality of life)
Effect Size: Rate ratio 0.91 (95% CI 0.60-1.37) for investigator-assessed CB; 1.13 (95% CI 0.80-1.58) for SGRQ-C CB; no significant difference in SGRQ-C changes
Population: Patients with COPD and eosinophilic phenotype (blood eosinophils ≥300 cells/μL, mMRC ≥2, moderate-to-severe airflow limitation, chronic bronchitis)

Result:

PubMed: 42617837DOI: 10.1016/j.chest.2026.07.5242

Mechanism Graph

Both mepolizumab and dupilumab target type 2 inflammation pathways (IL-5 and IL-4/IL-13, respectively)
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MAIC reweighted individual patient data from mepolizumab trials to match aggregate baseline characteristics of dupilumab trials
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Patients were matched on restrictive eligibility criteria (eosinophil count, mMRC, airflow limitation, chronic bronchitis)
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No statistically significant difference in exacerbation reduction or quality of life improvement was observed

Limitations

  • ⚠Indirect comparison, not a head-to-head randomized trial; potential residual confounding despite matching
  • ⚠Matching was based on aggregate data from dupilumab trials, which may not capture all patient-level characteristics
  • ⚠Chronic bronchitis definition varied (investigator-assessed vs SGRQ-C), leading to different patient subsets and results

Frequently Asked Questions

What is the main finding of this study?▼

The study found no statistically significant difference between mepolizumab and dupilumab in reducing moderate/severe exacerbations or improving quality of life in COPD patients with eosinophilic phenotype.

How was the comparison made?▼

The comparison was made using a matching-adjusted indirect comparison (MAIC), which reweighted individual patient data from mepolizumab trials to match the aggregate baseline characteristics of dupilumab trials.

What were the inclusion criteria for patients in this analysis?▼

Patients had COPD with blood eosinophil counts ≥300 cells/μL, mMRC grade ≥2, moderate-to-severe airflow limitation, and chronic bronchitis (defined by investigator or SGRQ-C).

What are the implications for clinical practice?▼

The results suggest that either mepolizumab or dupilumab may be used as add-on therapy for COPD with eosinophilic phenotype, with no clear efficacy advantage of one over the other based on this indirect comparison.

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References

  1. 1.Bourbeau J, Min J, Kolterer S, Yang S, Hunger M, Wang X, Sciurba FC. "Mepolizumab and Dupilumab Show No Significant Difference in Reducing Exacerbations in Patients with COPD and an Eosinophilic Phenotype: Matching-Adjusted Indirect Treatment Comparison.." Chest, 2026. PMID: 42617837 DOI: 10.1016/j.chest.2026.07.5242
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.