Real-World Effectiveness of Biologic Therapies in COPD patients with Type 2 Inflammation: Impact on Hospitalizations and Exacerbations

Background Chronic obstructive pulmonary disease (COPD) exacerbations significantly impair quality of life, accelerate disease progression and increase hospitalizations and risk of mortality. Biologic therapies aimed at type 2 (T2) inflammation have shown promise in recent clinical trials, however data in real world patients, who are more diverse and have more comorbid disease are lacking. We aim to evaluate if biologic therapies in COPD patients with T2 inflammation are associated with reductions in exacerbations in a real-world cohort of patients. Study Design and Methods A retrospective review of the electronic medical record (2016-2023) was performed. Patients who had COPD that were treated with biologics were included. Data collected included demographics, baseline comorbidities, imaging findings of emphysema, eosinophil count, and pulmonary function testing. The primary outcome was the change in moderate and severe exacerbations in the year prior and post initiation of therapy. Results 56 patients (mean age 71 ± 8.5, 50% female, 33.9% non-white) were included in the study. 55% had coronary artery disease, 71% hypertension, 14% stroke, 30% diabetes. Mean baseline predicted FEV1 was 41 ± 20, RV 159 ± 48.8 and DLCO 42 ± 18. Biologics significantly reduced moderate exacerbations from 3.63 ± 2.6 to 2.0 ± 2.4, for a mean reduction of 1.63 (95% CI 1.080-2.179, p<0.001). Hospitalizations decreased 1.34 ± 1.92 to 0.48 ± 1.14, with mean reduction of 0.86 (95% CI 0.420-1.295, p < 0.001). These reductions were not associated with degree of emphysema or GOLD stage. There were no significant changes in pulmonary function testing. Interpretation In a cohort of real-world COPD patients with T2 inflammation, biologics significantly reduced COPD-related hospitalizations and exacerbations despite having a higher burden of comorbid disease, and several markers of more severe COPD than in clinical trials. These findings support and expand on the accumulating data that biologics have benefit in COPD patients.