Abstract Introduction Although COPD is mainly associated with neutrophilic inflammation, eosinophilic inflammation also plays a key role. Patients with eosinophilic COPD have more frequent exacerbations and hospitalizations. Biological therapies targeting eosinophilic pathways may reduce exacerbation rates and mortality. This study aims to provide a timely, rigorous, and continuously updated synthesis of evidence concerning the role of biological therapies in COPD management. Methods We are conducting a Living Evidence Synthesis, with this being the first update following our baseline review (May 2023). We continuously monitored emerging evidence on biologics’ effects on exacerbations, lung function, and quality of life. Searches were run in relevant databases using Epistemonikos’ automated procedures, and results were screened via the “Living Overview of Evidence (L.OVE)” platform. Two reviewers independently selected and assessed randomized controlled trials (RCTs) comparing biologics to standard care in adults with COPD. Primary outcomes included 12-month exacerbation rates, lung function, and quality of life. Meta-analyses were conducted where appropriate, and evidence certainty was evaluated using the GRADE approach. Results Initial searches retrieved 24 systematic reviews, 2 evaluating the use of biologics on COPD, including 6 RCTs. Additional searches retrieved 125 RCTs. Ultimately, 9 RCTs were included. Update searches retrieved 169 RCTs. Ultimately, 1 RCTs was included. Across up to ten RCTs, biological therapy reduced mean annual COPD exacerbations over 12 months (MD −0.15; 95% CI −0.23 to −0.07; high certainty) but did not lower exacerbation risk at 52 weeks (RR 1.00; 95% CI 0.94 to 1.07; moderate certainty). No clinically relevant differences were found in quality of life (MD −0.13; 95% CI −0.22 to −0.04; low certainty), FEV1 (MD 0.03; 95% CI 0.03 to 0.05; low certainty), or total adverse events (RR 1.01; 95% CI 0.99 to 1.04). Severe adverse events were modestly reduced (RR 0.87; 95% CI 0.80 to 0.94; high certainty). Conclusions Biologic therapies reduce exacerbations over 12 months with high certainty. Their effects on lung function and quality of life remain uncertain. No significant safety concerns were observed. Dupilumab probably reduces exacerbation risk and improves SGRQ scores with moderate certainty. This abstract is funded by: No funding
Morales et al. (Fri,) studied this question.