Factors Influencing the Efficacy and Safety of Monoclonal Antibody Biologics in Chronic Obstructive Pulmonary Disease: A Meta-analysis of Randomized Controlled Trials.

backgroundMonoclonal antibody therapies targeting specific inflammatory pathways have shown potential in treating chronic obstructive pulmonary disease (COPD). However, the efficacy and safety of these treatments across different patient phenotypes remain uncertain.

methodsThis meta-analysis included 15 registered randomized controlled trials (RCTs) evaluating monoclonal antibodies targeting type 2 and non-type 2 inflammatory pathways in COPD. The primary outcomes assessed were rates of moderate to severe exacerbations, rates of severe exacerbations, lung function (pre- and post-bronchodilator FEV

resultsMonoclonal antibody therapies significantly reduced the rates of moderate to severe exacerbations (RR 0.88, 95% CI 0.83-0.93) and severe exacerbations (RR 0.82, 95% CI 0.72-0.94). Subgroup analyses revealed more pronounced benefits in eosinophilic and frequent exacerbator phenotypes. Non-eosinophilic patients demonstrated a better response to IL-33-targeting therapies. Lung function and quality of life showed modest improvements across most therapies. Smoking status and baseline FEV

conclusionsMonoclonal antibody therapies, particularly those targeting type 2 inflammation, effectively reduce exacerbation rates in COPD, with greater benefits observed in patients with eosinophilic phenotypes and frequent exacerbations. Baseline lung function also influences treatment response. These findings underscore the importance of personalized, phenotype-driven treatment approaches and support the continued development of biologics for COPD management.