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Biológicos en la EPOC: Estado actual y perspectivas futuras
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
Resumen
Las terapias biológicas son prometedoras para la enfermedad pulmonar obstructiva crónica (EPOC) al dirigirse a la inflamación específica. Dupilumab y mepolizumab benefician a los pacientes con recuentos altos de eosinófilos, lo que resalta la necesidad de estrategias de tratamiento basadas en endotipos.
Área de la Ciencia:
- Neumología; Inmunología; Farmacología
Sus antecedentes:
- El manejo de la enfermedad pulmonar obstructiva crónica (EPOC) enfrenta desafíos debido a su heterogeneidad y complejas vías inflamatorias.; La comprensión reciente de la fisiopatología de la EPOC apoya el desarrollo de terapias biológicas dirigidas.
Objetivo del estudio:
- Revisar la evidencia actual de ensayos clínicos para terapias biológicas en la EPOC.; Evaluar la eficacia de los biológicos basada en endotipos inflamatorios específicos y biomarcadores.
Principales métodos:
- Revisión sistemática de ensayos clínicos de Fase 3 que involucran agentes biológicos en pacientes con EPOC.; Análisis de datos de eficacia estratificados por características del paciente y perfiles de biomarcadores inflamatorios, particularmente recuentos de eosinófilos en sangre.
Principales resultados:
- Dupilumab (anti-IL-4/IL-13) y mepolizumab (anti-IL-5) demostraron reducciones significativas en las exacerbaciones en pacientes con EPOC con recuentos altos de eosinófilos (≥300 células/μL).; Otros biológicos (benralizumab, tezepelumab, inhibidores de IL-33/ST2) mostraron eficacia variable, a menudo ligada a biomarcadores específicos y subconjuntos de pacientes.; Los intentos iniciales dirigidos a la inflamación no tipo 2 tuvieron un éxito limitado, lo que enfatiza la necesidad de una endotipificación precisa.
Conclusiones:
- Las terapias biológicas ofrecen beneficios clínicos significativos para poblaciones seleccionadas de EPOC definidas por endotipos inflamatorios, particularmente aquellas con inflamación eosinofílica.; La estratificación precisa de pacientes mediante biomarcadores es crucial para optimizar los resultados de la terapia biológica en la EPOC.; Se necesita más investigación para establecer resultados a largo plazo, refinar los umbrales de biomarcadores y desarrollar tratamientos para fenotipos de EPOC no eosinofílicos.
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