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Biologics in Chronic Obstructive Pulmonary Disease: Current Status and Future Prospects.

Joon Young Choi1

  • 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Tuberculosis and Respiratory Diseases
|February 8, 2026
PubMed
Summary

Biologic therapies show promise for chronic obstructive pulmonary disease (COPD) by targeting specific inflammation. Dupilumab and mepolizumab benefit patients with high eosinophil counts, highlighting the need for endotype-based treatment strategies.

Keywords:
BenralizumabBiologicsChronic Obstructive Pulmonary DiseaseDupilumabEosinophilic InflammationMepolizumabTezepelumab

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Area of Science:

  • Pulmonology
  • Immunology
  • Pharmacology

Background:

  • Chronic obstructive pulmonary disease (COPD) management faces challenges due to its heterogeneity and complex inflammatory pathways.
  • Recent understanding of COPD pathophysiology supports the development of targeted biologic therapies.

Purpose of the Study:

  • To review current clinical trial evidence for biologic therapies in COPD.
  • To assess the efficacy of biologics based on specific inflammatory endotypes and biomarkers.

Main Methods:

  • Systematic review of Phase 3 clinical trials involving biologic agents in COPD patients.
  • Analysis of efficacy data stratified by patient characteristics and inflammatory biomarker profiles, particularly blood eosinophil counts.

Main Results:

  • Dupilumab (anti-IL-4/IL-13) and mepolizumab (anti-IL-5) demonstrated significant reductions in exacerbations in COPD patients with high eosinophil counts (≥300 cells/μL).
  • Other biologics (benralizumab, tezepelumab, IL-33/ST2 inhibitors) showed variable efficacy, often linked to specific biomarkers and patient subsets.
  • Initial attempts targeting non-type 2 inflammation had limited success, emphasizing the need for precise endotyping.

Conclusions:

  • Biologic therapies offer significant clinical benefits for selected COPD populations defined by inflammatory endotypes, particularly those with eosinophilic inflammation.
  • Precise patient stratification using biomarkers is crucial for optimizing biologic therapy outcomes in COPD.
  • Further research is needed to establish long-term outcomes, refine biomarker thresholds, and develop treatments for non-eosinophilic COPD phenotypes.