COPD 2.0: Bronchodilators, biologics and beyond - A systematic review

Area of Science:

• Pulmonology
• Immunology
• Pharmacology

Background:

• Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease with persistent airflow limitation and inflammation.
• Conventional treatments like bronchodilators have limitations, with many patients experiencing uncontrolled disease.
• Eosinophilic COPD phenotypes represent a subgroup that may benefit from targeted therapies.

Purpose of the Study:

• To systematically review the efficacy, safety, and clinical implications of biologic agents in COPD management.
• To evaluate novel therapeutic approaches for COPD, focusing on personalized medicine.
• To assess the impact of biologics on specific COPD phenotypes, particularly eosinophilic ones.

Main Methods:

• Comprehensive literature search of PubMed, Scopus, and Cochrane Library up to March 2025.
• Inclusion of randomized controlled trials, cohort studies, and real-world evidence on biologic treatments.
• Focus on studies evaluating monoclonal antibodies targeting eosinophilic inflammation (e.g., anti-IL-5, anti-IL-4/13).

Main Results:

• Biologic therapies, including anti-interleukin (IL)-5 and anti-IL-4/13 agents, demonstrate significant benefits in COPD subgroups with high eosinophil counts and frequent exacerbations.
• These treatments are associated with reduced exacerbation rates and improved quality-of-life scores.
• The safety profile of these biologic agents in COPD patients is generally acceptable.

Conclusions:

• Biologic therapies represent a significant advancement in personalized COPD management, particularly for eosinophilic phenotypes.
• These novel treatments offer a new frontier for patients with uncontrolled COPD despite conventional therapies.
• Further research is needed to establish long-term safety, cost-effectiveness, and broader applicability of biologics in COPD.