Efficacy and Safety of Mepolizumab in Eosinophilic COPD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVE: To evaluate the efficacy and safety of mepolizumab, a humanized monoclonal antibody that targets interleukin-5, a key mediator in eosinophilic inflammation, in reducing moderate-to-severe exacerbations among patients with eosinophilic chronic obstructive pulmonary disease (COPD). DATA SOURCES: PubMed, Scopus, Web of Science, and Cochrane databases were systematically searched using the terms: "Mepolizumab," "COPD," "Chronic Obstructive Pulmonary Disease," for randomized controlled trials comparing subcutaneous mepolizumab (100 mg every 4 weeks) with placebo in patients with eosinophilic COPD from inception till July 2025. STUDY SELECTION AND DATA EXTRACTION: Randomized controlled trials comparing subcutaneous mepolizumab with placebo in adults with eosinophilic COPD were included. Two independent reviewers screened studies and extracted data. Finally, 4 studies with a total of 1953 patients were included. Of these, 978 (50.0%) received mepolizumab. DATA SYNTHESIS: = 0.031) was significantly lower in the mepolizumab group.Relevance to Patient Care and Clinical Practice in Comparison With Existing Drugs:Mepolizumab provides a targeted, biomarker-guided treatment option, potentially reducing exacerbations without the added safety concerns like infections and metabolic complications as seen with existing therapies. CONCLUSION AND RELEVANCE: Mepolizumab reduces the time to first moderate or severe exacerbation and prolongs symptom-free periods in patients with eosinophilic COPD, without increasing the risk of AEs.