COPD Biologics Expand Options as Biomarker Rules Limit Access

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The expanded use of biologics to treat patients with chronic obstructive pulmonary disease (COPD) is a substantial advancement in COPD care.

The biologic therapies approved for COPD, which target IL-5 and IL-4 receptor alpha, have shown "really dramatic results" in improving lung function and reducing exacerbations, Geoffrey Chupp, MD, a pulmonologist specializing in lung diseases that affect the airway at Yale Medicine, said in an interview with The American Journal of Managed Care^®. These drugs were already used successfully to treat asthma, and broadening their use into COPD has been a major opportunity for patients and clinicians, including for patients who have features of both asthma and COPD, Chupp said. Yet access barriers remain.¹

“Now, the current drugs that are approved are really only for patients who have eosinophil levels that are elevated,” Chupp explained.

Biologic eligibility that relies on elevated eosinophil counts may limit which patients can access these therapies. Experts have also called for noninvasive biomarkers that are easy to perform everywhere and that patients can afford, along with more detailed biomarkers. Francesca Puggioni, MD, an adjunct professor of respiratory diseases at Humanitas University in Milan, Italy, has said a combined score of biomarkers could give clinicians a better idea of the complexity of a patient’s disease.¹

“I think that we'll see more drugs coming down the pike, potentially against alarmins that will hopefully be less restrictive in terms of biomarker requirements,” Chupp said.

Even though biomarker requirements may limit access, the expansion has shifted COPD care and the way doctors evaluate patients with the disease and their treatment.

“I think that we now see COPD in a broader light; I think in a much more biologic fashion related to asthma and allergic-type or T2-high-type inflammation, not just strictly a T2-low neutrophilic inflammatory disease with emphysema and chronic bronchitis,” Chupp explained. “I think it's really changing how we manage patients…and understand all the environmental features that could be contributing to their disease severity.”

References

1. McCrear S, Puggioni F. Closing the gap between trials and real-world care. AJMC^®. September 10, 2026. Accessed October 5, 2026. https://www.ajmc.com/view/closing-the-gap-between-trials-and-real-world-care