Nicola Hanania, MD, MS: Triple Therapies & Biologics in COPD


The current treatment landscape for chronic obstructive pulmonary disease (COPD) includes long-acting beta2 agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) in combination, as well as inhaled cortical steroids (ICS). However, biologics are also entering clinical trials, which could serve as novel, potential therapies for COPD in the future.

While at the 2018 CHEST Annual Meeting in San Antonio, TX, Nicola Hanania, MD, MS, director of the Airways Clinical Research Center at Baylor College of Medicine, spoke with MD Magazine® and outlined the ruling on triple therapies and the future of biologics for COPD.

MD Mag: How effective are triple therapies for COPD?

Hanania: We are starting to learn about fixed-dose triple therapies. Naturally, in our clinic, we often have patients on 2 inhalers—1 containing a LABA/LAMA, the other 1 containing an ICS—but not on fixed inhalers.

Now, there is emerging data from fixed triple therapies. One is approved in the United States, another is approved in Europe. These agents show, no matter what study you look at, superiority in the subgroup of patients with high exacerbation risks.

Triple therapies have an important role, but maybe [more so] in the more severe patients [and] those with high risk of exacerbation. And, that beneficial role may extend to patients with high blood eosinophils.

It [high blood eosinophils] seems to be a good marker, although there is a big debate [over] what is a good cutoff above which you would start an ICS. People are thinking maybe around 150 cells at baseline would be a good cutoff. Again, I have to mention that nobody has good evidence that this is a good, real cutoff.

MD Mag: Where is the future of COPD treatment headed?

Hanania: Right now, the big push is to look at biologics targeting different inflammatory mediators. We have made quite a bit of achievement in asthma. We have 4 biologics approved—maybe 2 more to come in the next year.

In COPD, we—unfortunately—don’t have any biologics approved. There is some work being done, and I think that’s a very important target.

There are certain early studies looking at different pathways we can block that may help these patients. Many of these agents being studied are in phase 2 trials though, and so it is too early to tell whether they are going to work or not.

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