GSK is advancing regulatory submissions for Nucala (mepolizumab) as an add-on maintenance treatment for chronic obstructive pulmonary disease (COPD) patients exhibiting an eosinophilic phenotype. This development follows positive results from the Phase III MATINEE trial, which demonstrated a significant and clinically meaningful reduction in the rate of moderate to severe exacerbations compared to placebo when added to inhaled maintenance therapy. The potential approval of Nucala could provide a much-needed targeted therapy for a significant subset of COPD patients.
The US Food and Drug Administration (FDA) has accepted the data from the MATINEE study for review, setting a Prescription Drug User Fee Act (PDUFA) date of May 7, 2025. Simultaneously, the China National Medical Products Administration (CNMPA) has also accepted the new drug application for Nucala in the same indication. These regulatory advancements signal a potential expansion of Nucala's use beyond its current approvals for severe asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic granulomatosis with polyangiitis (EGPA), and hypereosinophilic syndrome (HES).
MATINEE Trial Details
The MATINEE trial enrolled 804 COPD patients with evidence of type 2 inflammation, characterized by blood eosinophil counts. The study included patients with diverse clinical presentations, such as emphysema-only, chronic bronchitis-only, or a combination of both. Patients were treated for 52-104 weeks. The primary endpoint was met, showing a statistically significant and clinically meaningful reduction in the annualized rate of moderate/severe exacerbations versus placebo.
Clinical Significance
COPD affects over 390 million people globally and more than 14 million in the US, placing a substantial burden on healthcare systems. Recurrent exacerbations significantly contribute to the annual direct medical costs of COPD, with emergency department visits and inpatient care costing the US healthcare system approximately $7 billion annually. Up to 40% of COPD patients exhibit type 2 inflammation, making them potential candidates for Nucala treatment. Nucala targets interleukin-5 (IL-5), a key cytokine in type 2 inflammation, which is responsible for the growth, activity, and survival of eosinophils.
Current COPD Treatment Landscape
Currently, COPD management primarily involves inhaled maintenance therapies. Nucala's potential approval would introduce a biologic option with monthly dosing, offering a novel approach for patients with an eosinophilic phenotype. Other recent advancements in COPD treatment include Sanofi and Regeneron's Dupixent (dupilumab) and Verona Pharma's Ohtuvayre (ensifentrine), indicating a growing focus on addressing the diverse needs within the COPD patient population.
GSK's Respiratory Focus
GSK is committed to advancing respiratory medicine through innovative treatments and a comprehensive portfolio of vaccines, targeted biologics, and inhaled medicines. The company aims to improve outcomes and the lives of individuals living with various respiratory diseases, including asthma, COPD, refractory chronic cough, and rarer conditions like systemic sclerosis with interstitial lung disease.
