Biologics at the Forefront: Evolving Asthma and COPD Care Toward Precision

Over the past decade, respiratory medicine has undergone a profound evolution, spurred by deepening knowledge of asthma and chronic obstructive pulmonary disease (COPD) pathophysiology and a surge of innovative biologic therapies. What was once a landscape dominated by inhaled corticosteroids and long-acting bronchodilators has shifted toward an era of precision medicine defined by phenotype-based treatment selection, biomarker-guided strategies, and proactive intervention earlier in the disease course. These advancements have raised the standard of care for patients who previously faced limited options for achieving meaningful disease control and better quality of life.

In asthma, approvals of biologics targeting IL-4/IL-13, IL-5, and TSLP have transformed the management of severe disease, broadening eligibility beyond traditional eosinophilic or allergic phenotypes.1 Meanwhile, in COPD, the 2024 approval of dupilumab for eosinophilic COPD has opened new doors for targeted therapy in a population that long lagged behind asthma in biologic innovation.2 These developments have not only challenged historical treatment paradigms but also underscored the growing importance of individualized care and multidisciplinary collaboration.

To explore these paradigm shifts and their practical implications, HCPLive convened a clinical forum featuring leading allergists and pulmonologists, led by Anas Hadeh, MD, Director, Pulmonary and Critical Care Medicine Fellowship Program, Cleveland Clinic Florida, to discuss optimal approaches to phenotyping, treatment escalation, biologic selection, and strategies for bridging gaps between asthma and COPD management.

Participants acknowledged that biologics are reshaping asthma care, offering targeted, well-tolerated treatment options for patients with Type 2 inflammation, especially those with severe disease and steroid dependence. Dupilumab was cited as a common first choice due to efficacy and comorbidity overlap, although overall, they praised the safety seen with biologics in the real-world, which is largely incomparable to biologic use in other fields.

Supporting this shifting paradigm is patient phenotyping using biomarkers and comorbidity profiles to choose the right biologic, although insurance barriers often limit ideal prescribing practices.

"The bottom line is we need more biomarkers. We need validated biomarkers... the introduction of the biologics helps us come up with the biomarkers in the back. In fact, a lot of these pathways are only there because biologics were made and then they had to figure out where they were working," a participant said.

"I had a patient with eosinophilic granulomatosis with polyangiitis that I prescribed a biologic to a week ago and it got denied... It got denied because they want the patient to be on a month of steroid before they can approve the biologic. So these are real world [experiences]. Sometimes the guidelines tell you, look at the GINA guidelines, remember the step 5 ladder when you add the biologic. But real life is whatever the insurance dictates," Hadeh said.

They outlined the current emerging role of biologics in treating COPD, although the field is newer and still evolving, with biologics only available for people with type 2 inflammation/eosinophilic COPD.

"We need better ways to phenotype asthma, we need better ways to phenotype COPD, we need head-to-head studies on all the biologics because we extrapolate from one to another with completely different experimental circumstances," a panelist said.

Overall, the clinicians emphasized the importance of phenotyping to continue supporting the growing use and development of biologics for both asthma and COPD, which they predict will become longer lasting to reduce patient burden.

REFERENCES

1. FDA Approves Tezspire™ (Tezepelumab-ekko) in the U.S. for Severe Asthma. News release. Amgen. December 17, 2021. https://www.amgen.com/newsroom/press-releases/2021/12/fda-approves-tezspire-tezepelumabekko-in-the-us-for-severe-asthma
2. Dupixent® (dupilumab) Approved in the U.S. as the First-ever Biologic Medicine for Patients with COPD. Regeneron Pharmaceuticals, Inc. September 27, 2024. https://www.globenewswire.com/news-release/2024/09/27/2954552/0/en/Dupixent-dupilumab-Approved-in-the-U-S-as-the-First-ever-Biologic-Medicine-for-Patients-with-COPD.html.