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Alvar Agustí, MD, previews key 2027 GOLD report changes, from initial COPD treatment and new biologic data to a GOLD Science Committee call to action.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is set to release its 2027 report, the latest annual revision of its global strategy for COPD diagnosis, management, and prevention. The update follows a clarification of the 2026 guidance on initial pharmacologic therapy, which GOLD leadership published in the European Respiratory Journal.¹
New biologic data have also reshaped the evidence base for patients with persistent exacerbations. In the replicate phase 3 OBERON and TITANIA trials, published in The New England Journal of Medicine, add-on tozorakimab, an anti-interleukin-33 monoclonal antibody, reduced annualized moderate to severe exacerbations among former smokers by 29% and 34%, respectively, compared with placebo.²
The US Food and Drug Administration (FDA) has accepted a biologics license application for tozorakimab under Priority Review, with a decision expected in the first quarter of 2027, according to AstraZeneca.³ Until regulators act, investigational biologics such as tozorakimab sit outside GOLD’s pharmacologic treatment algorithm, leaving clinicians to weigh emerging trial data against formal recommendations.
Alvar Agustí, MD, PhD, chair of the GOLD Board of Directors and professor of medicine at the University of Barcelona, will present the 2027 GOLD Report with Claus F. Vogelmeier, MD, chair of the GOLD Science Committee, in Session 6: 2027 GOLD Report and Review/COPD Call to Action, from 1:35 to 2:25 PM, followed by audience Q&A. Ahead of the session, Agustí spoke with HCPLive’s editorial team at the GOLD 2026 COPD International Conference in Philadelphia about the report’s most consequential changes, the evidence behind them, and a new GOLD Science Committee call to action:
Alvar Agustí, MD, PhD: Well, there are several parts. For instance, the whole rehab chapter has been rewritten. The chapter on cardiovascular disease diagnosis and management has been completely rewritten with the help of some cardiologists. There has been a clarification on the initial treatment for patients…And of course, there are many other things: the discussion of pre-COPD, PRISm, COPD in young individuals, and the whole issue of underdiagnosis. So actually, it has a lot of changes that are relevant.
One thing people may want to look at is the pharmacological algorithm and the role of biologics. Let me tell you, the algorithm is the same as last year, but we are including in the text, not in the algorithm, information on 2 new biologics…The reason they are not in the algorithm yet is that neither the FDA nor the EMA has approved the drugs. GOLD cannot recommend drugs that have not been approved, but we recognize the evidence. So there are many changes.
Alvar Agustí, MD, PhD: Well, as I said, there are several important things, and if I had to pick one, it would be the publication of tozorakimab in The New England Journal of Medicine: 2 randomized clinical trials showing exacerbations can be reduced very significantly on top of triple therapy. As I said, this is not yet in the algorithm because the FDA has not approved it, but I’m sure they will.
Alvar Agustí, MD, PhD: Well, the GOLD Science Committee has written a collective paper…This is being reviewed now in 5 different international journals. We already received some criticisms, and we responded to those criticisms, so we think it will soon be published in 5 major international journals. Contrary to the guideline document, which reviews the available evidence and the current recommendations, this document discusses what we should do in the field. What evidence should we generate to improve the bottlenecks we know are there? Diagnosis, treatment, comorbidities. So, I think this will be a very important paper…hopefully also in several international journals soon, and I’ll present, tomorrow, some of these data.
Editor’s Note: This summary transcript has been edited for grammar and clarity using artificial intelligence tools.
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