Abstract Rationale Many patients with chronic obstructive pulmonary disease (COPD) continue to experience exacerbations despite receiving standard of care with optimized inhaled treatment. While current guidelines recommend rescue medication such as oral corticosteroids (OCS), these can lead to increased adverse events with long-term use. Mepolizumab is a humanized anti-interleukin-5 monoclonal antibody recently approved as an add-on to triple therapy in patients with COPD and an eosinophilic phenotype. This study aimed to characterize patients who initiated mepolizumab to treat COPD in the US, before approval. Methods This real-world retrospective longitudinal study used healthcare claims data from the Komodo Research database (01/2016─06/2024). The index date was defined as the first mepolizumab claim. Eligible patients had ≥2 mepolizumab claims from index to end of observation, were aged ≥40 years at index, had ≥12 months of eligibility (continuous health insurance coverage or clinical activity) pre-index, and had ≥2 COPD diagnosis claims during baseline (i.e., 12 months pre-index). Patients were excluded if they had ≥2 asthma diagnosis claims during baseline. Outcomes evaluated were COPD exacerbations and OCS utilization during baseline and 12 months of follow-up (i.e., pre- and post-mepolizumab initiation, respectively). Results Of the 693 eligible patients, 343 (49.5%) were female, 510 (73.6%) were white, and mean age was 64.6 years. The majority of patients were indexed in 2022 (158 22.8%) and were prescribed mepolizumab by a respiratory specialist (320 46.2%). In the 60 patients with a blood eosinophil count (BEC) assessment during baseline, 42 (70%) had a BEC ≥150 cells/µL and 27 (45%) a BEC ≥300 cells/µL. Pre-mepolizumab, most patients experienced ≥1 moderate/severe exacerbation (490 70.7%), with a mean (SD) number of 2.0 (2.1). Patients also experienced a mean (SD) of 0.34 (0.88) COPD-related hospitalizations, with a mean length of stay of 5.7 (4.1) days, 0.6 (1.3) COPD-related emergency department visits, and 7.0 (12.6) COPD-related outpatient visits.In the 470 patients with ≥12 months of eligibility pre- and post-mepolizumab, the rate reduction in moderate/severe COPD exacerbations post- versus pre-mepolizumab was 41% (P 0.001). The rate reduction in OCS dispensing and OCS bursts post- versus pre-mepolizumab was 26% (P 0.001) and 33% (P 0.001), respectively. Significantly fewer patients had ≥1 OCS dispensing post-mepolizumab (70.4%) versus pre-mepolizumab initiation (81.9%; P 0.001; Figure). Conclusions In patients with COPD from a real-world setting, post-mepolizumab, moderate/severe exacerbation rates and OCS utilization were significantly reduced compared with pre-mepolizumab. Pre-mepolizumab, patients experienced high exacerbation burden, with high healthcare resource utilization. Funding GSK (300073). This abstract is funded by: GSK (300073)
Panettieri et al. (Fri,) studied this question.
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