"An antibody treatment reduces the rate of flareups by nearly  percent in patients with a subgroup of treatmentresistant chronic obstructive pulmonary disease COPD according to the results of two large international trials presented today at the European Respiratory Society International Congress in Milan Italy and simultaneously published in the New England Journal of Medicine. The goal of precision medicine is to give the right treatment to the right patient said lead author Frank Sciurba M.D. director of the Center for COPD and Emphysema and UPMC Pulmonary Function Exercise Physiology Laboratory and visiting professor in the Division of Pulmonary Allergy and Critical Care Medicine University of Pittsburgh School of Medicine. These findings are the first example of a precision therapy that is uniquely effective in a subgroup of patients with treatmentresistant COPD.  COPD a progressive lung disease characterized by airway obstruction and chronic lung inflammation affects  million Americans.  There is significant variation between patients in the cells and other proteins responsible for lung inflammation so there are actually many different subtypes of COPD said Sciurba. One subgroup called eosinophilic predominant COPD is present in as many as  percent of patients and is characterized by elevated levels of a type of white blood cell known as eosinophils he said. The new study reports the results from two Phase III clinical trials evaluating the efficacy of mepolizumab an antibody treatment that reduces the number of eosinophils in the blood in moderate to severe treatmentresistant eosinophilic COPD by blocking the proinflammatory effects of interleukin. Patients included in the trials were still having flareups despite a year of a standard treatment known as triple inhaled therapy that includes bronchodilators and glucocorticoids. These patients already have been given every treatment we have to offer them and are still having flareups that significantly interfere with their quality of life and can lead to deterioration in lung function and higher mortality said Sciurba. We hoped to be able to offer them an option.  Mepolizumab is already approved by the Food and Drug Administration FDA to reduce symptom flareups and improve quality of life in eosinophilic asthma.  The first trial termed METREX was conducted at  sites in  countries from  to . A total of  COPD patients were stratified by blood eosinophil counts and randomized to receive either  milligrams of mepolizumab or placebo delivered under the skin every four weeks for one year. The patients with high eosinophil counts who received mepolizumab had a statistically significant  percent lower rate of moderatesevere exacerbations . per year compared to . per year than those in the placebo group. The exacerbation rate in the low eosinophil group treated with the biologic did not differ from placebo. The time to the first exacerbation also was higher with mepolizumab than placebo but only in the high eosinophil group.  In a second simultaneous trial termed METREO the team assessed the effect of a higher dose of mepolizumab in  patients with elevated eosinophil levels. Patients were randomized to receive  or  milligrams of mepolizumab or placebo with the same delivery method and schedule as METREX. Similar to METREX the exacerbation rate was reduced by  percent in the high eosinophil group after  milligrams of mepolizumab. The METREO results narrowly missed statistical significance. The milligram dose did not provide an advantage over the lower dose.  An analysis of data from both trials found that as baseline blood eosinophil counts increased so did mepolizumabs reduction in the annual exacerbation rate. This finding indicates that patients with higher initial eosinophil counts benefited more from mepolizumab than those with lower eosinophil counts Sciurba said. The safety profile of mepolizumab did not differ from placebo in either trial. In addition to providing a new treatment option for patients with treatmentresistant moderate to severe COPD the new results also are important because they identify a potential biomarker for the disease and demonstrate that eosinophilic inflammation plays a role in flareups in COPD Sciurba said. Pitts Division of Pulmonology Allergy and Critical Care Medicine has a legacy of pioneering treatments for lung disease. UPMC also is home to a leading lung transplant program.  The findings in these trials exemplify what we hope to achieve not only in COPD but across all lung diseases with regards to a precision approach to treatment said division chief Rama Mallampalli M.D.  Funding for both trials was provided by GlaxoSmithKline which plans to seek approval from the FDA for the use of mepolizumab in eosinophilic COPD. Additional authors on the study are Ian Pavord F.Med.Sci. D.M. University of Oxford UK Pascal Chanez M.D. Ph.D. CIC Nord AixMarseille University France Gerard Criner M.D. Temple University Huib Kerstjens M.D. Ph.D. University of Groningen the Netherlands Stephanie Korn M.D. Ph.D. Mainz University Hospital Germany Njira Lugogo M.D. Duke University JeanBenoit Martinot M.D. CHU UCL Namur Belgium Hironori Sagara M.D. Ph.D. Showa University Japan and Frank Albers M.D. Ph.D. Eric Bradford M.D. Stephanie Schweiker Harris B.Sc. Bhabita Mayer M.Sc. David Rubin M.D. and Steven Yancey M.Sc. all of GlaxoSmithKline. Patients wishing to learn more about the research being performed at the Center for COPD and Emphysema can call  or email ecrcupmc.edu mailtoecrcupmc.edu.  About the University of Pittsburgh School of Medicine As one of the nations leading academic centers for biomedical research the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates Pitt has ranked among the top  recipients of funding from the National Institutes of Health since . In rankings recently released by the National Science Foundation Pitt ranked fifth among all American universities in total federal science and engineering research and development support. Likewise the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs for which it is recognized as an innovative leader and to training highly skilled compassionate clinicians and creative scientists wellequipped to engage in worldclass research. The School of Medicine is the academic partner of UPMC which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the regions economy. For more information about the School of Medicine see http http"