A NEW nationwide Belgian study highlights the effectiveness of anti-interleukin-5 (IL5) therapy in reducing exacerbations among patients with obstructive lung disease, including those with coexisting chronic obstructive pulmonary disease (COPD) and asthma. The research shows that targeting eosinophilic inflammation can lead to substantial reductions in both moderate and severe exacerbations in a real-world setting.
Anti-IL5 Therapy Improves Outcomes Across Diverse Lung Disease Populations
The study included 807 adults who started anti-IL5 therapy, either mepolizumab or benralizumab, between 2017 and 2019. Researchers compared exacerbation rates in the year before therapy initiation with the year after. Severe exacerbations, defined as those requiring hospitalisation, decreased from 40±4 per 100 patient-years before treatment to 17±3 afterward, representing a 56% relative risk reduction and a number needed to treat (NNT) of just four. Patients without COPD also benefited, with exacerbations falling from 15±2 to 6±1 per 100 patient-years (NNT=11), while those with coexisting COPD saw rates drop from 119±12 to 53±9 (NNT=2).
Moderate exacerbations, treated with antibiotics, oral corticosteroids, or both, were also reduced across the cohort. However, oral corticosteroid (OCS)-only exacerbations in patients with both COPD and current smoking habits were less responsive to anti-IL5 therapy. Despite this, hospitalisations in these patients were still markedly reduced, underscoring the therapy’s impact on severe outcomes.
Hospitalisation Reduction Highlights Real-World Impact of Anti-IL5 Treatment
The findings suggest that anti-IL5 therapy provides meaningful benefits beyond clinical trials, especially for high-risk groups such as current smokers and patients with overlapping COPD and asthma features. While moderate OCS-treated exacerbations may be less responsive in some populations, the prevention of hospitalisations remains a critical advantage.
This real-world evidence supports the use of anti-IL5 therapy as a targeted approach to managing eosinophilic inflammation in obstructive lung disease, highlighting its potential to improve patient outcomes and reduce healthcare burden. Clinicians should consider these findings when evaluating treatment options, particularly for patients with severe disease or coexisting COPD.
Reference
Vanfleteren LEGW et al. Real-life impact of anti-IL5 therapy on exacerbation types in patients with obstructive lung disease. BMJ Open Respiratory Research. 2025;12(1):e003413.
