Navigating the Evolving COPD Care Landscape: A Call for Proactive Biologic Intervention

Sponsored by GSK

Chronic obstructive pulmonary disease (COPD) is a challenging condition that restricts airflow and commonly involves inflammation of the airways (bronchitis) and/or destruction of the alveoli (emphysema).¹ As of 2018, this chronic respiratory condition affects approximately 16 million people in the United States.¹

As a practicing physician, I have witnessed firsthand the challenges that both clinicians and patients face. From the standpoint of a clinician, despite some of our optimal inhaled therapies, patients may continue to exacerbate, and they can become concerned about the potential for that exacerbation to lead to hospitalization.

As physicians, we strive to reduce the risk of debilitating exacerbations in patients with COPD. In terms of treatment plans for people with COPD, this can typically include a daily maintenance inhaler. That said, 50% of people living with COPD still experience exacerbations while they're being treated with maintenance therapies, according to a paper published in the New England Journal of Medicine.² Waiting until after a patient experiences additional exacerbations overlooks the potential benefits of earlier, targeted interventions.

This article will outline the clinical rationale for prompt implementation of biologic therapy in COPD, focusing on identifying the best candidates for these add-on therapies to help prevent exacerbations.

The Imperative of Early Intervention in COPD

In my clinical experience, I generally see patients at the more advanced stages of their COPD. Some patients continue to exacerbate after everyday activities, like walking up a flight of stairs, walking in the house, or dressing for the day. With the approval of triple inhaler therapy, there was a sense of excitement for additional therapies that showed an exacerbation reduction benefit for people with COPD. ² That said, there were still those who continued to experience serious exacerbations because of this progressive disease.

Hospitalizations resulting from exacerbations represent a major healthcare challenge for people with COPD.³ The exacerbation-hospitalization cycle that many of them encounter places a substantial burden on the U.S. healthcare system³ and has concerning statistics for those individuals going through the advanced stages of disease. As COPD hospitalizations represent a major healthcare challenge, it is projected to become the leading cause of medical admissions, surpassing even ischemic heart disease hospitalizations according to the World Health Organization.³

In light of COPD being such a heterogeneous and burdensome disease, science has focused on identifying new targets for therapy. Eosinophils, a type of white blood cell that is a biomarker for type 2 inflammation and may indicate a higher risk of exacerbation, can be measured by a complete blood count with differential.⁴ Early identification of patients with COPD and elevated blood eosinophil levels who are at high risk for exacerbations is critical to implementing personalized treatment strategies, particularly for those who continue to experience exacerbations despite optimized triple inhaler therapy. Timely intervention in this population may help reduce future exacerbations.

It is well documented in the medical literature that eosinophils are a marker of type 2 inflammation and that a patient’s risk of exacerbation increases with a higher blood eosinophil count.⁴ The approval of biologic therapies provides important therapeutic options for healthcare professionals treating COPD, specifically for patients who exhibit an eosinophilic phenotype and continue to experience frequent exacerbations despite adherence to triple inhaler therapy. While traditional corticosteroids have an important place in therapy, the goal of biologics is to specifically target the cytokines involved in the underlying inflammatory pathways.⁵

NUCALA (mepolizumab): COPD with an Eosinophilic Phenotype

One biologic therapy option is NUCALA, an add-on maintenance treatment for adult patients with inadequately controlled COPD and an eosinophilic phenotype.⁶ NUCALA is not indicated for the relief of acute bronchospasm. Please see full Prescribing Information for NUCALA.

Important Safety Information for NUCALA

CONTRAINDICATIONS

Known hypersensitivity to mepolizumab or excipients.

Please see below for full Important Safety Information for NUCALA.

NUCALA is the only once-monthly biologic therapy approved for adult patients with COPD who exhibit an eosinophilic phenotype.⁷ This includes patients who have a blood eosinophil count of at least 150 cells/μL.⁸

Integrating NUCALA Into Clinical Practice

After seeing the results of the Phase 3 METREX and MATINEE studies of mepolizumab, I have a newfound hope for reducing exacerbations in patients with COPD and an eosinophilic phenotype.^6,9 Eosinophilic inflammation is increasingly recognized as a distinct and treatable endotype within the heterogeneous landscape of COPD, contributing to exacerbation frequency. NUCALA targets IL-5, a key cytokine responsible for the growth, differentiation, recruitment, activation, and survival of eosinophils.^6,9 By inhibiting IL-5, NUCALA can reduce circulating eosinophil levels that contribute to eosinophil-driven inflammation in the airways. The mechanism of action of NUCALA has not been definitively established.

When initiating NUCALA, clear and comprehensive communication with patients is essential to promote understanding of efficacy and safety while addressing potential misconceptions. In addition to outlining the potential benefits, physicians should engage patients in a dialogue to reinforce their comprehension of the therapy and its implications. Key questions to consider include:

• “Do you understand why we’re recommending this specific medication for your COPD?” to gauge their initial comprehension of the eosinophilic phenotype.
• “How do you feel this medication will fit into your current treatment routine, and what are your expectations for its effect on your flare-ups?” to uncover any unrealistic expectations or concerns about integration.
• “What questions do you have about how NUCALA works, its potential side effects, or what to do if you miss a dose?” to proactively address common anxieties and reinforce adherence strategies.

This interactive approach not only empowers patients by fostering shared decision-making, but also allows clinicians to identify and correct any misunderstandings regarding the role of NUCALA as a targeted add-on maintenance therapy and its place within the patient’s overall COPD management plan. By ensuring patients truly grasp how NUCALA may fit into their COPD management plan, alongside the practical aspects of its administration and the importance of consistent follow-up, we can optimize treatment outcomes.

Making Precision-Based Treatment for COPD a Reality

The emergence of targeted biologic interventions like NUCALA represents a pivotal paradigm shift in COPD management, moving us toward a proactive, precision-based approach.

In light of the potentially severe course of this disease, I encourage all physicians to consider the transformative role of targeted biologics, to prioritize screening for eosinophilic phenotypes, and to engage in evidence-based discussions with eligible COPD patients about the potential of these therapies to help prevent exacerbations.

Important Safety Information for NUCALA

CONTRAINDICATIONS

Known hypersensitivity to mepolizumab or excipients.

WARNINGS AND PRECAUTIONS

Hypersensitivity Reactions

Hypersensitivity reactions (eg, anaphylaxis, angioedema, bronchospasm, hypotension, urticaria, rash) have occurred with NUCALA. These reactions generally occur within hours of administration but can have a delayed onset (ie, days). Discontinue if a hypersensitivity reaction occurs.

Acute Symptoms of Asthma or COPD or Acute Deteriorating Disease

NUCALA should not be used to treat acute symptoms or acute exacerbations of asthma or COPD, or acute bronchospasm.

Opportunistic Infections: Herpes Zoster

Herpes zoster infections have occurred in patients receiving NUCALA. Consider vaccination if medically appropriate.

Reduction of Corticosteroid Dosage

Do not discontinue systemic or inhaled corticosteroids abruptly upon initiation of therapy with NUCALA. Decreases in corticosteroid doses, if appropriate, should be gradual and under the direct supervision of a physician. Reduction in corticosteroid dose may be associated with systemic withdrawal symptoms and/or unmask conditions previously suppressed by systemic corticosteroid therapy.

Parasitic (Helminth) Infection

Treat patients with pre-existing helminth infections before initiating therapy with NUCALA. If patients become infected while receiving NUCALA and do not respond to anti-helminth treatment, discontinue NUCALA until infection resolves.

ADVERSE REACTIONS

The most common adverse reactions (≥5%) were back pain, diarrhea, and cough.

USE IN SPECIFIC POPULATIONS

The data on pregnancy exposures are insufficient to inform on drug-associated risk. Monoclonal antibodies, such as mepolizumab, are transported across the placenta in a linear fashion as the pregnancy progresses; therefore, potential effects on a fetus are likely to be greater during the second and third trimesters.

Indication

NUCALA is indicated for the add-on maintenance treatment of adult patients with inadequately controlled chronic obstructive pulmonary disease (COPD) and an eosinophilic phenotype. NUCALA is not indicated for the relief of acute bronchospasm.

NUCALA (mepolizumab) injection is available as a 100 mg vial, Autoinjector, and prefilled syringe.

Please see Prescribing Information for NUCALA.

For more information on how NUCALA may benefit your appropriate patients currently on triple therapy, please visit www.NUCALAHCP.com

References

1. What is COPD?. November 8, 2024. National Heart Lung and Blood Institute. Available at: https://www.nhlbi.nih.gov/health/copd. Accessed December 11, 2025.
2. Rabe KF, Martinez FJ, Ferguson GT, et al. Triple inhaled therapy at two glucocorticoid doses in moderate-to-very-severe COPD. N Engl J Med. 2020;383(1):35-48
3. American Lung Association. COPD Trends Brief – Burden. Available at: https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief/copd-burden. Accessed December 11, 2025.
4. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2026 Report. https://goldcopd.org/2026-gold-report/. Accessed November 25, 2025.
5. American Lung Association. Understanding Your COPD Medications. Available at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/treating/copd-medications Accessed December 11, 2025.
6. NUCALA [package insert]. Durham, NC: GSK; 2025.
7. Sciurba FC, Criner GJ, Christenson SA, et al. Mepolizumab to prevent exacerbations in COPD with an eosinophilic phenotype. N Engl J Med. 2025;392:1710-1720.
8. Pavord ID, Chanez P, Criner GJ, et al. Mepolizumab for eosinophilic chronic obstructive pulmonary disease. N Engl J Med. 2017;377(17):1613-1629.
9. Data on file, GSK.

Trademarks are owned by or licensed to the GSK group of companies.

©2026 GSK or licensor.

PMUS-MPLCOCO250003 January 2026

Produced in USA.