Abstract
Background: Although the predominant airway inflammation in chronic obstructive pulmonary disease (COPD) is neutrophilic, approximately 20–40% of COPD patients present with eosinophilic airway inflammation. Compared with non-eosinophilic COPD patients, eosinophilic COPD patients are characterized by a greater number of total exacerbations and higher hospitalization rates. Furthermore, anti-interleukin-5 (IL-5) therapy, consisting of monoclonal antibodies (mAbs) targeting IL-5 or IL-5 receptor α (IL-5Rα), has been proven to be effective in severe eosinophilic asthma. This meta-analysis aimed to determine the efficacy and safety of anti-IL-5 therapy in eosinophilic COPD. Methods: We searched the PubMed, Web of Science, Embase, and Cochrane Library databases from inception to August 2020 (updated in June 2021) to identify studies comparing anti-IL-5 therapy (including mepolizumab, benralizumab, and reslizumab) with placebo in eosinophilic COPD patients. Results: Anti-IL-5 therapy was associated with a decrease in acute exacerbation rate (RR 0.89; 95% CI 0.84 to 0.95, I 2 = 0%) and the severe adverse events (RR 0.90; 95% CI 0.84 to 0.97, I 2 = 0%). However, no significant improvement was observed in pre-bronchodilator forced expiratory volume in 1 s (FEV1) (WMD 0.01; 95% CI −0.01 to 0.03, I 2 = 25.9%), SGRQ score (WMD −1.17; 95% CI −2.05 to −0.29, I 2 = 0%), and hospital admission rate (RR 0.91; 95% CI 0.78 to 1.07, I 2 = 20.8%). Conclusion: Anti-IL-5 therapy significantly reduced the annual acute exacerbation rate and severe adverse events in eosinophilic COPD patients. However, it did not improve lung function, quality of life, and hospitalization rate.
Highlights
Chronic obstructive pulmonary disease (COPD) is characterized by progressive and irreversible airflow limitation that is triggered by the response of the airways and the lungs to noxious particles or fumes (Dave and Arjun, 2021)
The exacerbation of COPD is associated with increased healthcare costs (Hilleman et al, 2000; Toy et al, 2010), progressive loss of lung function, subsequent cardiovascular events, and decline in quality of life (Dransfield et al, 2017; Kunisaki et al, 2018)
We searched the PubMed, Web of Science, Embase, and Cochrane Library databases from inception to August 2020 to identify studies comparing anti-IL-5 therapy with placebo in COPD patients
Summary
Chronic obstructive pulmonary disease (COPD) is characterized by progressive and irreversible airflow limitation that is triggered by the response of the airways and the lungs to noxious particles or fumes (Dave and Arjun, 2021). It is a leading cause of chronic morbidity and mortality worldwide (Dave and Arjun, 2021). Anti-interleukin-5 (IL-5) therapy, consisting of monoclonal antibodies (mAbs) targeting IL-5 or IL-5 receptor α (IL-5Rα), has been proven to be effective in severe eosinophilic asthma. This meta-analysis aimed to determine the efficacy and safety of anti-IL-5 therapy in eosinophilic COPD
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