Personalized COPD Treatment: Lessons from Biologic Trials and Clinical Practice

Over the past decade, chronic obstructive pulmonary disease (COPD) management has undergone a profound evolution. Once defined primarily by symptom control and inhaled therapy optimization, the field is now entering an era of targeted, biology-driven treatment. Advances in understanding COPD’s heterogeneity—especially the role of Type 2 inflammation—have opened the door to new therapeutic strategies that go beyond bronchodilation and corticosteroids. This transformation mirrors earlier breakthroughs in asthma and reflects a broader shift toward precision medicine across respiratory care.

The approval of biologics such as dupilumab (Dupixent) for COPD in 2024 marked a major milestone, introducing the first targeted therapy with proven efficacy in reducing exacerbations and improving lung function in patients with elevated eosinophil counts. Additional agents under study, including mepolizumab and benralizumab, are helping to refine how clinicians define and treat inflammatory subtypes of COPD.1,2 These approvals have shifted the field to spotlighting inflammatory pathways once thought peripheral to COPD pathophysiology that are now central to its treatment paradigm.

At a recent clinician forum in Miami, experts led by Meilan Han, MD, professor of medicine and Chief of the Division of Pulmonary & Critical Care at the University of Michigan, discussed how these developments are reshaping real-world COPD care, from identifying ideal biologic candidates to integrating these treatments into existing care models. The conversation captured both the optimism and complexity of this moment: how to bridge the gap between groundbreaking science and practical implementation, and how to ensure that access, education, and collaboration evolve alongside the science itself.

During the discussion, faculty highlighted the shifting understanding of COPD as a heterogeneous disease with inflammatory subtypes amenable to biologic therapy. They reviewed key trial data showing dupilumab’s success in reducing exacerbations and improving FEV₁ among patients with Type 2 inflammation, as well as emerging evidence for other biologics targeting IL-5 pathways. The conversation emphasized the importance of biomarkers, namely eosinophil counts, for guiding therapy and defining subpopulations that stand to gain the most from these new treatments.

"Even in asthma studies, we always thought of mepolizumab as a one-trick pony, sort of eosinophil only and not affecting the other side of the pathway. And dupilumab, to me, seemed [to have slightly] better data, even as an anti-inflammatory drug. So, generally, I'm a little biased towards dupilumab and I am more comfortable using it. Unless I see more data suggesting that mepolizumab would have something better to offer, it seems like I'm, for now, using [dupilumab] a lot more right now," one panelist said.

Panelists also discussed practical considerations in integrating biologics into COPD management, including payer barriers, clinician education, and patient selection. The consensus was that multidisciplinary collaboration among pulmonologists, primary care providers, and pharmacists will be critical for successful adoption. Together, the discussion captured a pivotal point in COPD care as biologics are moving from research to reality, signaling a new phase of personalized, inflammation-targeted therapy for a historically underserved population.

"Allergists, we do biologics for asthma patients with any comorbid conditions or who have needed hospitalizations, which has helped. So I'm more comfortable prescribing biologics, depending upon their condition, but I haven't prescribed any biologic for COPD. Most of the patients who have severe COPD, I would like them to see a pulmonologist as well," a panelist noted.

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.