Blood eosinophils in COPD: are biologics for everyone?
Vanetti Marco M, Visca Dina D, Ardesi Francesco F, Taglioretti Antonia M AM et al.
Type 2 (T2) biologics represent a promising treatment option for chronic obstructive pulmonary disease (COPD) patients with eosinophilic inflammation. To evaluate the prevalence of stable COPD patients who may be eligible for T2 biologics. Real-world, retrospective, monocentric study in COPD patients undergoing inpatient pulmonary rehabilitation. Clinical, functional, and inflammatory data were collected. Patients were considered eligible for T2 biologic therapy whether they were receiving optimized inhaled therapy and had a history of ⩾2 moderate and/or ⩾1 severe exacerbations in the previous year, together with a blood eosinophil count ⩾300 cells/μL. Among 441 patients, 21.5% had blood eosinophil counts ⩾300 cells/μL and 6.8% fulfilled the combined eligibility criteria. A high burden of respiratory and cardiometabolic comorbidities and increased cardiovascular risk was observed in the overall population. Only a subgroup of patients seems eligible for biologics, treatment escalation should be based on optimized standard care management and patient phenotyping.