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The National Institute for Health and Care Excellence (NICE) has recommended mepolizumab (Nucala; GSK) for adults with uncontrolled COPD and raised blood eosinophils for use on the NHS in England.
In final draft guidance published on 28 May 2026, NICE approved mepolizumab as an add-on treatment alongside triple therapy, including an inhaled corticosteroid, a long-acting beta-2-agonist and a long-acting muscarinic antagonist.
Mepolizumab is given by injection once every four weeks and can be self-administered, the draft guidance said.
COPD is defined as uncontrolled if patients have experienced one or more severe exacerbations, or two or more moderate exacerbations, in the previous 12 months.
In documentation accompanying its recommendation, NICE said that clinical trial evidence showed that mepolizumab plus triple therapy, when compared with placebo plus triple therapy, reduced the number of moderate or severe exacerbations.
The results of clinical trials also showed that the drug delayed the time before a first moderate or severe exacerbation occurred, NICE said.
Mepolizumab reduces production and survival of eosinophils. Studies have estimated that between 20 and 40% of people with COPD have elevated eosinophil levels, which has been associated with increased inflammation and risk of exacerbation.
The decision to recommend the drug for COPD comes ten years after NICE approved it for adults with severe asthma in 2016.
Sarah Sleet, chief executive of charity Asthma + Lung UK, commented: “Mepolizumab has the potential to change the lives of people with uncontrolled COPD by reducing the risk of exacerbations and sudden flare ups. COPD is a life-limiting illness that gets more severe over time and often stops people from performing basic daily tasks as some people are left fighting for breath.
“Only some people with uncontrolled COPD will be eligible for this treatment so more research is still needed to uncover new treatments for the condition.”
Darush Attar-Zadeh, honorary clinical fellow respiratory pharmacist at North West London Integrated Care Board, said publication of the guidance is “a fabulous milestone to reduce exacerbation frequency, and it will benefit the person living with COPD significantly”.
“While delaying subsequent events is vital, preventing the first flare-up in all COPD patient remains a priority. Advanced biologics are a welcome addition. They must supplement — not replace — the GOLD 5 Fundamentals of COPD Care: smoking cessation; vaccinations; pulmonary rehabilitation; self-management education; effective management of comorbidities. True disease modification relies on getting these five pillars right through shared decision-making for the wider COPD population.”
In January 2026, NICE approved dupilumab (Dupixent; Sanofi and Regeneron Pharmaceuticals), as an add-on maintenance treatment for adults with uncontrolled COPD and raised eosinophils.
In the final draft guidance for mepolizumab, NICE said that clinical trials had not directly compared mepolizumab plus triple therapy with dupilumab plus triple or double therapy.
It added that indirect comparisons suggest mepolizumab may not be as effective at reducing exacerbations, but that mepolizumab is cost saving compared with dupilumab.
