Beyond Triple Therapy: Anti-Type 2 Biologic Therapies for Eosinophilic COPD and Respiratory Comorbidities - a Review of Clinical Evidence
To review current evidence on biologic therapies targeting type 2 inflammation in patients with eosinophilic COPD and respiratory comorbidities who remain uncontrolled despite optimized triple inhaled therapy. Recent phase 3 trials have shown that dupilumab provides the most consistent benefit in eosinophilic COPD, reducing exacerbations and improving lung function and quality of life. Mepolizumab has shown a more limited effect, mainly on exacerbation reduction, whereas benralizumab has not demonstrated clear clinical benefit. Blood eosinophil count remains the main biomarker for treatment selection. Biologic therapies are advancing precision medicine in COPD, with dupilumab currently showing the strongest overall evidence. Careful patient selection is essential. Broader phenotyping may further improve management, as comorbidities such as chronic rhinosinusitis may contribute to symptom burden and support a multidisciplinary approach. Future studies should clarify long-term outcomes and optimal biologic selection.
Authors
- Davide Stivalini
- Cristiano Caruso (ORCID: https://orcid.org/0000-0001-7631-029X)
- Loreta Di Michele
- Davide Fontana (ORCID: https://orcid.org/0000-0003-4262-8368)
- David Selvaggio
- Veronica Ojetti (ORCID: https://orcid.org/0000-0002-8953-0707)
- Simone Ielo (ORCID: https://orcid.org/0009-0002-2838-423X)
- Pier‐Valerio Mari (ORCID: https://orcid.org/0000-0002-3307-217X)
- Valeria Gambacorta (ORCID: https://orcid.org/0000-0003-4875-1201)
- Stefano Baglioni (ORCID: https://orcid.org/0000-0002-5250-2868)
- Lorenzo Carriera (ORCID: https://orcid.org/0009-0006-2538-1278)
- Angelo Coppola
- Alberto Ricci
- Eugenio De Corso
- Roberto Lipsi
- Raffaele Scala
Institutions
- Università Cattolica del Sacro Cuore (IT)
- Università Campus Bio-Medico (IT)
- Agostino Gemelli University Polyclinic (IT)
- Azienda Ospedaliera San Camillo-Forlanini (IT)
- Saint Camillus International University of Health and Medical Sciences (IT)
- Ospedale San Filippo Neri (IT)
- Ospedale San Carlo (IT)
- Ospedale Cristo Re (IT)
- Ospedale Santa Maria (IT)
- Azienda Ospedaliera Sant'Andrea (IT)
- Ospedale San Donato (IT)
- University of the Sacred Heart (JP)
- Carlo Forlanini Hospital (IT)
- Misericordia University (US)
- Sapienza University of Rome (IT)
Publication Details
- Journal
- Current Allergy and Asthma Reports
- Published
- 2026-04-16
- DOI
- https://doi.org/10.1007/s11882-026-01271-8
- Primary Topic
- Chronic Obstructive Pulmonary Disease (COPD) Research
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Università Cattolica del Sacro Cuore