Current status of biologics in COPD
In Professor Alberto Papi’s comprehensive lecture on the evolving landscape of biological treatment in COPD, he emphasized the proven efficacy of triple therapy in reducing the annual exacerbation rate. Despite these advancements, challenges persist as some patients continue to experience exacerbations even with optimized triple therapy. This underscores the urgency for novel and individualized treatment approaches.
Navigating potential molecular targets in COPD
The complex task of navigating potential molecular targets poses a considerable challenge in this field. While exploring the non-type 2 inflammatory response, known for its involvement in exacerbations, studies on non-type 2 mediators like TNF and IL-17A have yielded inconclusive results (1, 2). Contrary to this, asthma has seen success with antibody treatments targeting type 2 inflammatory mediators, prompting exploration of their applicability in COPD.
Specifically, antibodies targeting IL-5 signaling, effective in certain asthma phenotypes, raise intriguing questions about their potential role in COPD. However, Prof. Papi shared conflicting findings regarding the impact of anti-IL-5 in COPD, emphasizing the need for more targeted studies in specific patient subgroups (3).
Blocking IL-4 and IL-13 – a potential breakthrough
An encouraging breakthrough emerged in the form of blocking IL-4 and IL-13 signaling, showing a promising 30% reduction in the annual exacerbation rate in a subgroup of COPD patients characterized by specific criteria (4). This development marks a significant leap forward, especially for individuals on triple therapy still experiencing exacerbations.
Alarmins may recall history of smoking
Diving further into the exploration of alarmins’ influence on COPD, studies on IL-33 inhibition revealed nuanced results. While there was no significant change in the overall exacerbation rate, a subgroup analysis showed a substantial reduction in frequency among former smokers (5). Ongoing research is dedicated exclusively to this population, promising deeper insights.
Work in progress
Prof. Papi concludes that while treatments for type 2 inflammatory mediators in COPD have progressed, addressing non-type 2 inflammation remains a work in progress. With hope, future research will unveil treatments for non-type 2 inflammation in COPD, given that it represents the majority of cases.
Recommended reading
Agusti A. Biologics for COPD – Finally Here. N Engl J Med. 2023 Jul 20;389(3):274-275. doi: 10.1056/NEJMe2305752. PMID: 37467502.
Written by
Ingvild Bjellmo Johnsen
Medical Advisor Respiratory, Chiesi Nordic
References
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