Emerging therapies to prevent acute exacerbations of chronic obstructive pulmonary disease (COPD): A Canadian perspective

This is the authors' abstract. We don't add key points for this paper.

Despite the use of triple therapy (inhaled corticosteroids, long-acting β2-agonists and long-acting muscarinic antagonists), many patients with chronic obstructive pulmonary disease (COPD) continue to experience acute exacerbations of COPD (AECOPD). Given the significant impact of AECOPD on both patients and healthcare systems, reduction of AECOPD is an important goal of COPD management. Numerous promising molecules, targeting a variety of inflammatory pathways, are being studied for treatment of COPD. Biologic molecules developed thus far inhibit either the interleukin 4 receptor (IL-4; dupilumab), IL-5 (mepolizumab), IL-5 receptor (benralizumab), or components of the IL-33/thymic stromal lymphopoietin (TSLP) alarmin inflammatory pathway (astegolimab, itepekimab, tezepelumab and tozorakimab). Of new small molecules, the most promising include a phosphodiesterase PDE3 and PDE4 inhibitor (ensifentrine), and a PDE4 inhibitor (tanimilast). Phase III trial data for dupilumab, mepolizumab and ensifentrine demonstrate their potential to reduce AECOPD frequency and improve outcomes in high-risk individuals. We discuss the clinical implications of targeted versus broad therapies and the potential for new, emerging therapies to address the unmet needs of high-risk patients with COPD. As more efficacy data emerge, these novel therapies will hopefully be incorporated into evidence-based treatment guidelines to provide improved care and health-related quality of life for patients with COPD.