Biologics in the Management of Chronic Obstructive Pulmonary Disease: Emerging Perspectives

Abstract

Inflammation is at the core of multiple, highly variable, and interconnected pathological processes, which will eventually sow the seeds of chronic bronchitis and/or emphysema in exposed and susceptible individuals. Low-grade chronic inflammation in these patients is acutely worsened during infectious, and to a lower extent, non‑infectious COPD exacerbations. Unfortunately, a large fraction of patients receiving contemporary anti-exacerbation prophylaxis–including that provided by inhaled combinations of long-acting β₂-adrenoceptor agonist (LABA), long-acting anti‑muscarinic (LAMA), and inhaled corticosteroids (ICS) (triple therapy)–remain frequent exacerbators. These patients have at least two moderate episodes and/or one severe episode requiring hospitalization or an emergency department visit in the preceding year. Given their higher risk of disease progression and premature death, recent national and international guidelines for pharmacological COPD treatment consider them as “high-risk” patients.

The hope of providing more effective protection against exacerbations through anti‑inflammatory, non-steroidal alternatives has sparked major research efforts in the past few years. This focused review will concisely highlight the pharmacological approaches based on anti-inflammatory biologics currently under investigation, emphasizing the few options more likely to be available in the Canadian market in 2025–2026. Two recent meta-analyses provide valuable information for those interested in further methodological details of the studies herein cited.