MedPath

Mepolizumab

Generic Name
Mepolizumab
Brand Names
Nucala
Drug Type
Biotech
CAS Number
196078-29-2
Unique Ingredient Identifier
90Z2UF0E52
Background

Eosinophils are involved in inflammatory immune responses, and prolonged hypereosinophilia (typically defined as absolute eosinophil levels of 1500/mm or more) is associated with a spectrum of diseases, including severe asthma, eosinophilic granulomatosis with polyangiitis (EGPA), and hypereosinophilic syndrome (HES). The pathogenesis of eosinophilia is complex, but IL-5 is recognized as a key cytokine involved in the differentiation, recruitment, activation, and prolonged survival of eosinophils in peripheral tissue. Activated eosinophils further stimulate an inflammatory response and also induce tissue lesions and promote fibrosis, all of which contribute to the multifactorial symptomatology of hypereosinophilic diseases.

Mepolizumab is a fully-humanized recombinant IgG1 kappa monoclonal antibody directed against IL-5 produced in Chinese hamster ovary cells. Mepolizumab was first approved by the FDA on November 4, 2015, as an add-on therapy for severe asthma and marketed under the brand name Nucala by GlaxoSmithKline. This indication was subsequently expanded to cover EGPA on December 12, 2017, and HES on September 25, 2020.

Indication

Mepolizumab is an anti-IL-5 IgG1 kappa monoclonal antibody indicated as an add-on maintenance treatment in patients aged six years and older with severe eosinophilic asthma and as a treatment in adult patients for eosinophilic granulomatosis with polyangiitis (EGPA). Mepolizumab is also indicated for the treatment of hypereosinophilic syndrome (HES) in patients aged 12 and older in whom eosinophilia is present for at least six months without an identifiable non-hematologic secondary cause.

Mepolizumab is additionally indicated as an add-on maintenance treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) in patients ≥18 years old with inadequate response to nasal corticosteroids.

Associated Conditions
Chronic Rhinosinusitis Phenotype With Nasal Polyps (CRSwNP), Eosinophilic Granulomatosis With Polyangiitis (Churg-Strauss) (EGPA), Hypereosinophilic Syndrome (HES), Severe Eosinophilic Asthma

GSK Acquires Efimosfermin for $1.2 Billion to Target Steatotic Liver Disease

• GSK has agreed to acquire efimosfermin alfa from Boston Pharmaceuticals for $1.2 billion upfront, with potential additional milestone payments of $800 million, strengthening its hepatology pipeline. • Efimosfermin, a phase III-ready FGF21 analog, has shown promising results in reversing liver fibrosis in patients with metabolic dysfunction-associated steatohepatitis (MASH), with a convenient once-monthly dosing regimen. • Steatotic liver disease affects approximately 5% of the global population with limited treatment options, and interventions that reduce fibrosis could save the US healthcare system between $40-100 billion over the next two decades.

ATS 2025 Conference to Showcase Groundbreaking Pulmonary Research and Patient-Centered Initiatives

• The American Thoracic Society (ATS) 2025 International Conference in San Francisco will feature cutting-edge research across pulmonary, critical care, and sleep medicine, drawing over 10,000 attendees from 85 countries. • Key clinical trials to be presented include studies on tezepelumab for asthma and chronic rhinosinusitis, mepolizumab for COPD, sotatercept for pulmonary arterial hypertension, and tirzepatide for obstructive sleep apnea. • The conference will emphasize patient advocacy through dedicated panels and introduce the Respiratory Innovation Summit, fostering collaboration between scientific leaders and industry partners to advance therapeutic development.

Takeda Spotlights Three Late-Stage Readouts as Potential "Inflection Point" Amid Vyvanse Generic Competition

• Takeda Pharmaceutical is positioning three upcoming late-stage clinical trial readouts as a strategic "inflection point" to offset revenue losses from Vyvanse's generic competition. • The Japanese pharmaceutical giant is focusing on new product launches and pipeline advancement to maintain growth momentum, with particular emphasis on rare disease and neuroscience therapeutic areas. • Industry analysts view Takeda's pipeline strategy as critical for the company's long-term financial stability, as it navigates the challenging transition period of losing exclusivity for one of its top-selling medications.

FDA Misses Review Deadline for GSK's Nucala COPD Expansion Amid Regulatory Delays

• The FDA has missed its May 7 target decision date for GSK's application to expand Nucala (IL-5 blocker) for use in chronic obstructive pulmonary disease. • GSK confirmed the delay but remains optimistic, stating they are "working closely" with the FDA and "continue to expect approval" based on recent discussions with regulators. • This incident adds to a pattern of FDA regulatory delays, including missed deadlines for Novavax's COVID-19 vaccine and Stealth BioTherapeutics' elamipretide, amid reports of significant staff reductions at the agency.

GSK's Linerixibat Shows Significant Improvement in Cholestatic Pruritus for Primary Biliary Cholangitis Patients

• GSK's phase III GLISTEN trial demonstrates linerixibat significantly improves cholestatic pruritus (relentless itch) in patients with primary biliary cholangitis, addressing a major quality of life concern. • The late-breaking results were presented at the European Association for the Study of the Liver (EASL) Congress 2025, highlighting the potential for a new treatment option for this challenging symptom. • Primary biliary cholangitis is a chronic autoimmune liver disease that primarily affects women, with pruritus being one of the most debilitating symptoms impacting daily functioning and quality of life.

FDA to Deploy AI Assistant Across All Centers by June 30 to Accelerate Scientific Reviews

• FDA Commissioner Martin Makary announced an agency-wide rollout of AI tools to assist with scientific reviews across all 11 FDA centers, with full deployment expected by June 30, 2025. • The AI assistant aims to handle repetitive aspects of regulatory reviews, allowing FDA scientists to focus on critical safety evaluations while potentially accelerating approval timelines for new therapies. • Implementation will be led by FDA's Chief AI Officer Jeremy Walsh and CDER's Strategic Programs Director Sridhar Mantha, with transparency measures including public release of user feedback and performance results.

FDA Leadership Shakeup: Peter Marks' Forced Resignation Sends Shockwaves Through Biopharma Industry

• Peter Marks, head of FDA's Center for Biologics Evaluation and Research since 2016, was forced to resign after refusing to support HHS Secretary Robert F. Kennedy Jr.'s vaccine safety claims. • The departure triggered significant stock declines for gene therapy and vaccine-focused companies including Taysha, Solid Biosciences, Sarepta and Novavax, with shares falling 5-10%. • Industry leaders express concern that FDA's scientific independence is under threat, with BMO Capital Markets analysts calling the resignation "a significant negative for the biopharma and biotech sectors." • Marks' exit follows other key FDA departures, including CDER head Patrizia Cavazzoni, raising questions about regulatory stability and the future of accelerated approvals for innovative therapies.

FDA Approves Blujepa, First New Class of Oral Antibiotic for UTIs in Nearly 30 Years

• GSK's Blujepa (gepotidacin) has received FDA approval for treating uncomplicated urinary tract infections, marking the first new class of oral antibiotics for UTIs in nearly three decades. • The novel triazaacenaphthylene antibiotic demonstrated non-inferiority or superiority to nitrofurantoin in clinical trials, offering a new treatment option amid rising antibiotic resistance concerns. • Blujepa works through a unique dual-enzyme inhibition mechanism that may reduce the potential for resistance development, with commercial availability expected in the second half of 2025.

Scotland Approves New Cancer Treatments for Prostate and Liver Cancers

• The Scottish Medicines Consortium (SMC) has approved talazoparib (Talzenna) in combination with enzalutamide for treating adults with prostate cancer, offering a targeted oral therapy option. • Cabozantinib (Cabozantinib Ipsen) has been accepted for treating adults with hepatocellular carcinoma (HCC) who have received previous treatment, expanding options for liver cancer patients. • The SMC rejected two other medications: ripretinib (Qinlock) for gastrointestinal stromal tumors and spesolimab (Spevigo) for generalised pustular psoriasis, citing cost-effectiveness and evidence uncertainties.

Tezepelumab Shows Remarkable 92% Reduction in Nasal Polyp Surgery Need in Phase 3 Trial

• Phase 3 WAYPOINT trial demonstrates tezepelumab significantly reduced nasal polyp severity and improved nasal congestion scores in patients with severe chronic rhinosinusitis with nasal polyps. • The study showed a dramatic 92% reduction in the need for nasal polyp surgery or systemic corticosteroid treatment compared to placebo over 52 weeks. • Patients receiving tezepelumab experienced significant improvements in multiple symptoms, including loss of smell and sino-nasal outcomes, with similar adverse event rates to placebo.

FDA Rejects AstraZeneca's Fasenra for Nasal Polyp Treatment, Additional Clinical Data Required

• The FDA has rejected AstraZeneca's application for Fasenra (benralizumab) in treating chronic rhinosinusitis with nasal polyps, requesting additional clinical data to support approval. • Fasenra demonstrated significant improvements in nasal polyp scores and blockage in the Phase 3 OSTRO trial, but AstraZeneca must now likely await results from the ongoing ORCHID study. • The rejection delays AstraZeneca's entry into a market currently dominated by Sanofi/Regeneron's Dupixent and GSK's Nucala, which generated $5.7 billion and $1.4 billion in sales respectively last year.

FDA Grants Priority Review to Dupixent for Bullous Pemphigoid Treatment

• The FDA has accepted Dupixent's supplemental biologics license application for priority review in treating bullous pemphigoid, with a decision expected by June 20, 2025. • Pivotal trial results showed five times more patients achieving sustained disease remission with Dupixent compared to placebo, demonstrating significant improvements in disease severity and itch reduction. • Approximately 27,000 adults in the US suffer from bullous pemphigoid uncontrolled by systemic corticosteroids, representing a significant unmet medical need in this elderly population.

FDA Grants Priority Review to Troriluzole for Spinocerebellar Ataxia Treatment

• Biohaven's troriluzole has received FDA Priority Review for treating spinocerebellar ataxia (SCA), potentially becoming the first FDA-approved treatment for this rare genetic neurodegenerative disease. • Clinical trials demonstrated troriluzole slowed SCA disease progression by 50-70% over three years, representing a 1.5-2.2 year delay in disease advancement compared to controls. • The FDA's decision on the New Drug Application is expected in Q3 2025, with Biohaven prepared to commercialize troriluzole in the US by 2025 if approved.

GSK's Portfolio Resilience: Cancer and HIV Gains Offset RSV Vaccine Decline

• GSK experienced a significant 51% decline in Arexvy RSV vaccine sales to £590 million in 2024, following restricted US recommendations limiting use to adults 75 and older. • Strong performance in oncology with 72% sales growth to £408 million, driven by Jemperli and Ojjaara, while HIV portfolio showed double-digit growth through Cabenuva, Apretude, and Dovato. • Despite vaccine challenges, GSK upgraded its long-term sales forecast to £40 billion by 2031, supported by pipeline progress and planned launches in respiratory, oncology, and infectious diseases.

Eli Lilly Seeks to Join Lawsuit on Compounded Drugs

Eli Lilly aims to join a lawsuit as a defendant against a compounding trade group's litigation with the FDA over the status of its drug tirzepatide, arguing it needs to protect its interests and ensure the swift resolution of the case.

Breakthroughs in Clinical Trials: A Week of Promising Developments

This week's clinical trials round-up highlights significant advancements in treatments for various conditions, including idiopathic pulmonary fibrosis, diabetes, COPD, and advanced solid tumours. Key developments include positive Phase 2 results for Faron Pharmaceuticals' BEXMAB trial, AstraZeneca's Phase 2a COURSE trial for COPD, and Johnson & Johnson's Phase 3 QUASAR maintenance study for ulcerative colitis.

GSK's Nucala (Mepolizumab) Approved in China for Chronic Rhinosinusitis with Nasal Polyps

• China's NMPA has approved GSK's Nucala (mepolizumab) as an add-on therapy for adults with chronic rhinosinusitis with nasal polyps (CRSwNP). • The approval marks the third indication for mepolizumab in China for IL-5 mediated conditions, offering a non-surgical option for patients. • The decision was based on Phase III MERIT trial results, showing significant improvement in nasal obstruction and reduction in nasal polyp score. • Nucala is a monoclonal antibody that targets interleukin-5 (IL-5), a key cytokine in type 2 inflammation, providing an alternative to systemic corticosteroids.

EMA Accepts GSK's Depemokimab for Review in Asthma and CRSwNP

• The European Medicines Agency (EMA) has accepted GSK's application for depemokimab as an add-on treatment for asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). • Depemokimab, a monoclonal antibody targeting IL-5, could become the first ultra-long-acting biologic with a six-month dosing schedule if approved. • Regulatory submissions are supported by positive results from the SWIFT and ANCHOR trials, demonstrating reduced exacerbations and polyp size, respectively. • Asthma affects over 42 million people in Europe, while CRSwNP impacts up to 4% of the general population, highlighting the need for new treatment options.

GSK's GSK'227 Receives FDA Breakthrough Therapy Designation for Relapsed Osteosarcoma

• The FDA granted Breakthrough Therapy Designation to GSK'227 for relapsed or refractory osteosarcoma after two prior lines of therapy. • The designation aims to expedite the development of GSK'227, a B7-H3-targeted antibody-drug conjugate, for this rare bone cancer. • The FDA's decision was based on promising data from the ARTEMIS-002 trial, which evaluated GSK'227 in osteosarcoma patients. • GSK'227 represents a potential new treatment option for osteosarcoma patients with limited alternatives after chemotherapy failure.

Olaparib Shows Sustained Benefit in Early-Stage BRCA-Mutated Breast Cancer

• Olaparib improves long-term survival in women with high-risk, early-stage breast cancer and BRCA1/2 mutations, reducing cancer recurrence risk by 35%. • After six years, 87.5% of olaparib-treated patients were alive, compared to 83.2% in the placebo group, demonstrating a significant survival advantage. • The OlympiA trial reinforces the importance of BRCA testing to identify patients who can benefit from personalized olaparib treatment early. • Olaparib is now recommended by NICE in England and Wales for early-stage, high-risk breast cancer with BRCA1/2 mutations, improving survival chances.
© Copyright 2025. All Rights Reserved by MedPath