Selecting a Biologic in COPD Management

The introduction of 2 biologics for patients with COPD with high blood eosinophils and frequent exacerbations marks an exciting advancement in treatment. Both therapies have demonstrated reductions in exacerbation risk and the need for oral steroids, which is particularly important since steroids can cause serious adverse effects, especially in patients with multiple health issues. Having these biologic options provides clinicians with new tools to better manage patients who previously had limited choices, potentially improving outcomes by breaking the cycle of frequent exacerbations and steroid use.

When deciding between the 2 biologics, there are some differences to consider, although no definitive guidelines currently exist. Factors such as blood eosinophil levels, presence of certain inflammatory markers, lung function, and patient preference for dosing schedules (every 2 weeks vs every 4 weeks) may guide treatment selection. Cost and insurance coverage also play significant roles in real-world decision-making. Clinicians acknowledge that it can sometimes take trial and error to determine which biologic yields the best response for a given patient, highlighting the need for personalized approaches in the absence of clear-cut criteria.

Ultimately, shared decision-making with patients is crucial, especially when costs are comparable. Patients’ preferences about injection frequency and convenience, as well as their tolerance for potential adverse effects, should be factored in. The availability of 2 biologics offers flexibility, allowing providers to switch therapies if the first choice does not produce adequate results. This evolving landscape reflects progress in COPD care but also underscores the need for further research to better clarify the optimal use of these new treatment options.