Biologics and Biomarkers in 2025: Evolving Strategies for Asthma and COPD

In 2025, asthma and chronic obstructive pulmonary disease (COPD) continue to challenge clinicians with their complexity and variability. While the rise of biologics and biomarkers has transformed care for patients with type 2 (T2) inflammation, questions remain about how best to apply these tools in real-world settings.

At a recent HCPLive clinical forum in Troy, Michigan, a panel of pulmonologists moderated by Arjun Mohan, MBBS, a clinical associate professor at the University of Michigan Health, and MeiLan Han, MD, MS, professor of Medicine and chief of the Division of Pulmonary and Critical Care at the University of Michigan Health, discussed the shifting treatment landscape and how evolving evidence is reshaping clinical practice.

“It's mind-boggling that in 2025, we still have patients who struggle with this illness,” Mohan said during his opening remarks on asthma. “Those who remain under control go on and have fixed airflow obstruction and continue to be at high risk of exacerbation.”

Mohan outlined the central role of T2 inflammation in asthma pathophysiology, noting that many patients fall under eosinophilic or allergic phenotypes. These patients are often candidates for biologics targeting IgE, IL-5, IL-4/IL-13, or TSLP.

“Biologics have revolutionized the treatment of asthma,” he said. “They have really led to the extinction of certain subsets of asthma populations, such as the chronic steroid-dependent asthmatic, even though we know those patients still exist.”

Yet selecting the right agent remains a nuanced decision. The panel emphasized the importance of using biomarkers—particularly blood eosinophils and FeNO—in tandem with clinical features to guide treatment. “FeNO is a favorite in our practice,” said Mohan. “It is noninvasive, it's quick to do, reimbursements for it are improving, so it's a biomarker that we track and trend quite frequently.”

Still, interpretation can be difficult. “You have to tie the biomarker back to what you think is the inflammatory state,” Mohan explained. “Just the presence of elevated eosinophils may not be the main driver of symptom burden.”

One panelist added, “If they've had more than 2 [exacerbations], they’re on chronic steroids… if they're clinically behaving like an uncontrolled asthmatic, you really need biomarkers.”

The discussion also addressed practical barriers to integrating biomarker testing into routine care. “Eosinophils are unstable, FeNOs are checked variably, most practices don’t check FeNOs,” Mohan said.

The panel discussed how biologic initiation often depends on achieving maximal inhaler optimization, addressing comorbidities such as obesity or GERD, and ensuring patient readiness. The panel also explored how comorbidities like nasal polyps or atopic dermatitis can influence the choice of agent.

In the second half of the session, Han discussed recent developments in COPD, including the expanding role of eosinophils as a biomarker. “We think somewhere between 30 and 40% of patients with COPD have some evidence of type 2 inflammation if we go based on elevated blood eosinophils,” she said.

Dupilumab was approved for eosinophilic COPD in 2024, followed by mepolizumab in 2025. While both target T2 inflammation, the clinical trial outcomes have differed. “Overall in MATINEE, there was actually no significant difference overall in either symptoms or lung function improvement,” Han highlighted, contrasting it with dupilumab’s broader impact on lung function and quality of life.

Looking ahead, the panel discussed depemokimab, a long-acting IL-5 inhibitor dosed every 6 months. “Patients love the idea of a twice-yearly injection,” Mohan said. “But we’re already seeing concerns about monitoring, missed doses, and logistical follow-up.”

Despite the expanding toolkit, Mohan acknowledged that biologic selection is often empirical. As both the evidence base and treatment armamentarium continue to expand, panelists reiterated the importance of personalization grounded in real-world practicality.

“The only reason we can ask these questions now is because we are in a point where we are starting to see the impact of all these data points in our clinical practice,” Mohan added.

Editor's note: These quotes have been lightly edited for grammar and clarity.

References:

1. Sanofi. Press Release: Dupixent approved in the US as the first-ever biologic medicine for patients with COPD. Sanofi.com. Published September 27, 2024. Accessed August 5, 2025. https://www.sanofi.com/en/media-room/press-releases/2024/2024-09-27-13-35-00-2954551

2. GSK. Nucala (mepolizumab) approved by US FDA for use in adults with chronic obstructive pulmonary disease (COPD) | GSK. Gsk.com. Published May 22, 2025. Accessed August 5, 2025. https://www.gsk.com/en-gb/media/press-releases/nucala-mepolizumab-approved-by-us-fda/