Targeting chronic obstructive pulmonary disease with type 2 biologics yields smaller effect sizes than in asthma due to fundamental biological differences, HCPLive reported from the GOLD 2026 COPD International Conference in Philadelphia.
Clinical trials testing asthma biologic therapies in chronic obstructive pulmonary disease have delivered mixed results. While type 2 inflammation drives most asthma cases, it represents only one component of chronic obstructive pulmonary disease, creating hurdles for clinicians targeting specific inflammatory pathways.
- Biologics: Advanced, targeted protein-based medications designed to block specific immune pathways involved in inflammation.
- Eosinophilic Phenotype: A subtype of chronic inflammation marked by an elevated count of eosinophils, a specific type of white blood cell.
- Effect Size: A statistical measurement showing the magnitude of a treatment’s benefit in clinical trials compared to a placebo.
Clinical trials of asthma biologics in chronic obstructive pulmonary disease have produced both successes and failures, according to Deepak Singh. Effect sizes have generally been smaller in chronic obstructive pulmonary disease, indicating a fundamental difference in underlying biology.
Type 2 inflammation is one component of chronic obstructive pulmonary disease but the dominant process in most patients with asthma, Singh explained. This distinction helps explain why some type 2 biologics effective in asthma have failed in chronic obstructive pulmonary disease trials.
Some patients with type 2 disease may simultaneously need broader biologic coverage, Singh noted during the Philadelphia conference sessions. He pointed to anti-alarmin therapy as a promising solution, given that this strategy can influence both type 2 and non-type 2 inflammatory mechanisms.
The field is now working to refine the use of type 2 biologics in chronic obstructive pulmonary disease, Singh reported. Healthcare providers treating asthma have grown accustomed to using clinical indicators and biomarkers to pair each individual with the most fitting biologic, and practitioners focusing on chronic obstructive pulmonary disease are adopting a comparable approach.
The session closed with a discussion of how clinicians might identify responders in everyday practice. Singh described two distinct approaches currently debated across pulmonary medicine.
Clinicians can utilize empiric treatment followed by assessment of response, which takes time and depends on how response is judged. Alternatively, clinicians can rely on prediction based on clinical characteristics and biomarkers.
Forecasting remains the preferred method within the discipline, and Singh stressed that it ought to remain central as novel therapies become available. Matching patient biomarkers to targeted mechanisms remains critical for optimizing therapeutic outcomes.
Patients with chronic obstructive pulmonary disease must not alter or discontinue maintenance inhaler regimens without direct medical supervision when considering biologic therapies. Biologics are precision injectables tailored to specific inflammatory phenotypes and are contraindicated in patients lacking the specific biomarker profile required for the drug’s mechanism of action.
The global pulmonary community continues to evaluate data presented at the GOLD 2026 COPD International Conference held from November 6, 2026, in Philadelphia, Pennsylvania.
- Singh D, Uller L, Brusselle G, Wedzicha JA. Targeting pathways in COPD: a glimpse into the future? Presented at: GOLD 2026 COPD International Conference; November 6, 2026; Philadelphia, PA.
- Bhatt SP, Rabe KF, Martinez FJ, et al. Dupilumab for COPD with blood eosinophil evidence of type 2 inflammation. N Engl J Med. 2024;390(24):2274-2283.
- Sciurba FC, Criner GJ, Christenson SA, et al. Mepolizumab to prevent exacerbations of COPD with an eosinophilic phenotype. N Engl J Med. 2025;392(17):1710-1720.
