AUTHOR=Zhang Chuchu , Wang Yalei , Zhang Meng , Su Xiaojie , Lei Ting , Yu Haichuan , Liu Jian 

TITLE=Monoclonal Antibodies Targeting IL-5 or IL-5Rα in Eosinophilic Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.754268

DOI=10.3389/fphar.2021.754268

ISSN=1663-9812

ABSTRACT=<p><bold>Background:</bold> 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.</p><p><bold>Methods:</bold> 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.</p><p><bold>Results:</bold> Anti-IL-5 therapy was associated with a decrease in acute exacerbation rate (RR 0.89; 95% CI 0.84 to 0.95, <italic>I</italic><sup><italic>2</italic></sup> = 0%) and the severe adverse events (RR 0.90; 95% CI 0.84 to 0.97, <italic>I</italic><sup><italic>2</italic></sup> = 0%). However, no significant improvement was observed in pre-bronchodilator forced expiratory volume in 1 s (FEV<sub>1</sub>) (WMD 0.01; 95% CI −0.01 to 0.03, <italic>I</italic><sup><italic>2</italic></sup> = 25.9%), SGRQ score (WMD −1.17; 95% CI −2.05 to −0.29, <italic>I</italic><sup><italic>2</italic></sup> = 0%), and hospital admission rate (RR 0.91; 95% CI 0.78 to 1.07, <italic>I</italic><sup><italic>2</italic></sup> = 20.8%).</p><p><bold>Conclusion:</bold> 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.</p>