Blood eosinophils in COPD: are biologics for everyone?

Abstract

Background: Type 2 (T2) biologics represent a promising treatment option for chronic obstructive pulmonary disease (COPD) patients with eosinophilic inflammation. Objectives: To evaluate the prevalence of stable COPD patients who may be eligible for T2 biologics. Design: Real-world, retrospective, monocentric study in COPD patients undergoing inpatient pulmonary rehabilitation. Methods: Clinical, functional, and inflammatory data were collected. Patients were considered eligible for T2 biologic therapy whether they were receiving optimized inhaled therapy and had a history of ⩾2 moderate and/or ⩾1 severe exacerbations in the previous year, together with a blood eosinophil count ⩾300 cells/μL. Results: Among 441 patients, 21.5% had blood eosinophil counts ⩾300 cells/μL and 6.8% fulfilled the combined eligibility criteria. A high burden of respiratory and cardiometabolic comorbidities and increased cardiovascular risk was observed in the overall population. Conclusion: Only a subgroup of patients seems eligible for biologics, treatment escalation should be based on optimized standard care management and patient phenotyping