Race-neutral GLI-2022 equations alter COPD trial eligibility in a northeast Asian COPD cohort

Extract Forced expiratory volume in 1 s (FEV₁) percent-predicted is a common eligibility criterion for pharmaceutical randomized controlled trials (RCTs) in chronic obstructive pulmonary disease (COPD). [1, 2] The Global Lung Function Initiative (GLI) recently introduced the race-neutral 2022-GLI reference equation to provide a unified global standard for lung function prediction, driven by concerns over health equity and the use of race as a biological variable. [3] Previous studies show that switching from other existing reference equations to 2022-GLI reference equation affects both the identification and severity of ventilatory defects. [4–6] To further understand its influence on patient care, this study aimed to evaluate the impact of adopting 2022-GLI reference equation on participant eligibility for pharmaceutical RCTs in COPD. Choi's reference equation, derived from a Korean population, has been widely used in clinical practice and research in Korea [7, 8]; however, its applicability may be limited by its population-specific nature and differences from more recently developed global reference equations. We hypothesized that, compared to Choi's reference equation, applying 2022-GLI reference equation for percent-predicted values of FEV₁ would change the proportions of patients eligible for pharmaceutical RCTs of COPD, and health outcomes would differ according to the concordance of trial eligibility status.