Anti-IL5/IL5R Treatment in COPD: Should We Target Oral Corticosteroid-Dependent Patients?

Abstract

Introduction

Monoclonal antibodies targeting interleukin 5 (IL5) or its receptor (IL5R) are frequently used in severe asthma, in which they reduce exacerbations rate and oral corticosteroids (OCS) exposure. Anti-IL5/IL5Rs have been studied in patients with chronic obstructive pulmonary disease (COPD) without convincing benefits. However, these therapies have been used in clinical practice in COPD with apparently good results.

Purpose

To describe the clinical characteristics and therapeutic response of COPD patients treated with anti-IL5/IL5R in a real-world setting.

Patients and Methods

This is a retrospective case series of patients followed at the Quebec Heart and Lung Institute COPD clinic. Men or women, with an established diagnosis of COPD, and treated either with Mepolizumab or Benralizumab were included. Demographics, disease and exacerbation-related data, airway comorbidities, lung function, and inflammatory profile were extracted from patients’ hospital files at baseline visit and 12 months post-treatment. Therapeutic response to biologics was assessed by measuring change in annual exacerbation rate and/or OCS daily dose.

Results

Seven COPD patients treated with biologics were identified (5M:2F). All were found to be OCSdependent at baseline. Radiological evidence of emphysema was found in all patients. One case was diagnosed with asthma before age 40. Residual eosinophilic inflammation was found in 5/6 patients (blood eosinophils count 237 ± 225×10⁶ cells/L) despite chronic OCS use. After 12 months of anti-IL5 treatment, mean OCS dose dropped from 12.0 ± 7.6 to 2.6 ± 4.3 mg/day, representing a 78% decrease. Annual exacerbations rate was reduced by 88%, from 8.2 ± 3.3 to 1.0 ± 1.2 per year.

Conclusion

Chronic OCS use is a common characteristic of patients treated with anti-IL5/IL5R biological therapies in this real-world setting. In this population, it may be effective in decreasing OCS exposure and exacerbation.

Keywords:

• COPD
• treatment
• anti-IL5
• monoclonal antibodies
• exacerbations
• oral corticosteroids

Acknowledgments

Jeremy Laroche received a summer scholarship from Laval University for working on this study.

Disclosure

Dr Andréanne Côté reports grants from GSK, advisory boards, presentations from Sanofi, GSK, AstraZeneca, and valeo, outside the submitted work. Dr Krystelle Godbout reports personal fees, advisory board Co Investigator in industry sponsored research from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Covis, personal fees, advisory board Co Investigator in industry sponsored research from GlaxoSmithKline, personal fees, advisory board Co Investigator in industry sponsored research from Sanofi, personal fees from Novartis, personal fees from Valeo, personal fees from TEVA, outside the submitted work. The authors report no other conflicts of interest in this work.