Pulmonary critical care physician, Cone Health

Nikita S. Desai, MD

Monoclonal Antibodies and the Future of Lung Preservation in COPD

, Joseph Khabbaza, MD, moderates an expert discussion with Nikita Desai, MD, and Eric Costanzo, MD, on the impact of and recent developments with monoclonal antibodies in chronic obstructive pulmonary disease (COPD).

In this clip, Desai and Costanzo reflected on the future direction of monoclonal antibody use in COPD, including sequencing, combination therapy, and long-term impact on disease progression. Desai highlighted that, while current use is largely shaped by payer approvals and clinical trial inclusion criteria, she typically assesses efficacy after 6 to 12 months before switching agents, acknowledging the need for head-to-head trials to inform sequencing decisions. Simultaneous biologic therapy, while mechanistically plausible, remains unlikely in the near future due to cost and logistical barriers.

Turning to disease modification, Costanzo emphasized the importance of early, upstream intervention to limit inflammatory cascades that drive irreversible lung remodeling. He underscored the clinical value of preserving lung function, noting that while COPD cannot be cured, biologics may arrest progression and mitigate long-term damage. Both clinicians agreed that unchecked type 2 or neutrophilic inflammation leads to structural changes and that the evolving use of targeted therapies offers an opportunity to protect lung health over time. As the field advances, they anticipate growing physiologic and imaging data will reinforce biologics’ role in modifying COPD's natural history.

The Biologic Era in COPD: What Mepolizumab Approval Means for Exacerbation Control

From Rescue to Routine: Early Use of Biologics in COPD

Targeting Type 2 Inflammation: COPD Lessons from Asthma Biology

Next-Gen COPD Trials: What Clinicians Need from Biologic Studies

Identifying COPD Candidates for Biologics: What Clinicians Should Know

is a pulmonary and critical care physician at the Cleveland Clinic and a director of the non-cystic fibrosis bronchiectasis program., who serves as the moderator for this panel discussion.

is a pulmonary critical care physician at Cone Health in Greensboro, North Carolina. She is triple board certified in critical care medicine, internal medicine, and pulmonary medicine.

is a pulmonary critical care and neurocritical care physician and program director of the Pulmonary and Critical Care fellowship at Jersey Shore University Medical Center with Hackensack Meridian Health System and Shore Pulmonary Associates

Relevant disclosures for Khabbaza include Insmed, Regeneron, Sanofi, and Baxter Healthcare Corporation. Desai and Costanzo have no relevant disclosures to report.

Nucala (mepolizumab) approved by US FDA for use in adults with chronic obstructive pulmonary disease (COPD). News release. GSK. May 22, 2025. https://www.gsk.com/en-gb/media/press-releases/nucala-mepolizumab-approved-by-us-fda/

Videos

In this video, the last in a 6-part series, panelists discuss the potential future impact of biologics in the COPD field.

In this clip, Costanzo and Desai explore how they approach real-world patient profiles when considering monoclonal antibody therapy for COPD. Costanzo emphasizes initiating early conversations about biologics, ideally at the time of diagnosis, to establish shared decision-making and to prepare patients for advanced treatment if disease progression or exacerbations occur. He underscores that even a single severe exacerbation or repeated steroid use should trigger evaluation for systemic inflammation and potential biologic initiation, particularly in patients with elevated eosinophil counts.

Desai highlights the clinical challenge of patients who remain well-controlled between occasional, virus-triggered exacerbations. In such cases, convincing patients to adopt biologics despite infrequent flares and few daily symptoms can be difficult. Both physicians stress the importance of individualized education, early expectation-setting, and rapport building to guide patients through treatment escalation when necessary.

Additionally, Desai points to encouraging real-world data suggesting that biologic therapies may lead to durable symptom remission even after discontinuation, reinforcing their long-term value beyond immediate exacerbation prevention. Ultimately, the panelists advocate for proactive, personalized COPD management that integrates biologics earlier in the treatment continuum to mitigate exacerbations, reduce corticosteroid exposure, and improve patient outcomes.

In this video, the fifth in a 6-part series, panelists discuss the factors that influence initiating biologics for COPD.

In this clip, Desai and Costanzo reflect on the limitations of current clinical trial designs evaluating monoclonal antibodies in COPD, particularly in light of the MATINEE study. Dr. Desai notes that MATINEE was conducted during the COVID-19 pandemic, a period of widespread masking, social distancing, and reduced viral exposure, factors that may have suppressed exacerbation rates and complicated generalizability to post-pandemic populations.

Both clinicians agree that future studies should extend follow-up duration and place greater emphasis on patient-reported outcomes, especially symptom burden and quality of life. While biologics have demonstrated efficacy in reducing exacerbation frequency and delaying time to first exacerbation, daily symptom relief is not guaranteed—a disconnect that underscores the importance of managing patient expectations around treatment goals. Desai emphasizes that improvements in time to exacerbation and corticosteroid reduction are clinically meaningful, but may not align with what patients value most.

Costanzo advocates for the inclusion of objective functional endpoints, such as 6-minute walk tests and exercise tolerance, to capture subtle improvements that may not be fully perceived by patients. Both experts agree that refining endpoints and extending trial duration will be essential to advancing the role of biologics in COPD care.

In this video, the fourth in a 6-part series, panelists discuss how future studies of monoclonal antibodies in COPD could be refined.

In this clip, Costanzo and Desai discuss the evolving understanding of type 2 inflammation in COPD and how this growing insight is reshaping treatment strategies. Once considered exclusive to asthma, type 2 inflammation is now recognized in up to 40% of COPD patients—a realization that is informing both diagnostic evaluation and therapeutic decision-making.

Costanzo emphasizes how academic programs have long recognized eosinophilic inflammation as a potential COPD phenotype, and now that phase 3 data supports targeted therapy, this concept is becoming part of standard care pathways. He describes how biologics are being introduced early in post-discharge treatment plans, incorporated into education for trainees, and discussed with patients as part of personalized COPD care.

Desai stresses the need to reframe clinician and patient perspectives around biologics, especially in contrast to systemic corticosteroids. While biologics are often perceived as "high-risk," short courses of prednisone carry well-documented long-term harms—including cardiovascular and metabolic risks—that patients often underestimate. Both experts agree that early biologic use can not only reduce exacerbation frequency but also prevent hospitalizations, where outdated high-dose steroid protocols still prevail.

The panelists theorize that future biologic development may expand beyond IL-4, IL-5, and IL-13 to target additional cytokines involved in type 2 inflammation, offering even more precise and steroid-sparing options for COPD patients.

In this video, the third in a 6-part series, panelists discuss how learnings from asthma management are informing COPD management.

Nikita S. Desai, MD

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