Dave Singh, MD, reflects on 2027 GOLD report refinements, from mucus plugs and early COPD to biologics awaiting regulatory approval.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) presented its 2027 report at the GOLD 2026 COPD International Conference in Philadelphia, where Alvar Agustí, MD, and Claus F. Vogelmeier, MD, reviewed the annual update to its global strategy related to
The update comes about as late-stage biologic data outpace regulatory approval. Tozorakimab, an anti-interleukin (IL)-33 monoclonal antibody, reduced annualized moderate to severe exacerbations among former smokers by 29% and 34% compared with placebo in the replicate phase 3 OBERON and TITANIA trials, published in The New England Journal of Medicine.²
Results for astegolimab, an anti-ST2 monoclonal antibody blocking IL-33 signaling, were mixed. The phase 2b ALIENTO trial met its primary end point with a 15.4% reduction in annualized exacerbation rate, while the phase 3 ARNASA trial showed a numerical 14.5% reduction without statistical significance, according to Roche.³
Neither agent is licensed for COPD, creating a gap between published evidence and prescribing access for clinicians reading the 2027 report. Outside of biologic drugs, the report’s refinements touch on clinical questions common in practice, including the interpretation of mucus plugs and the definitions used for earlier forms of disease.
Dave Singh, MB BChir, MA (Cantab), MRCP, MD, FBPhS, FERS, known for his work as professor of clinical pharmacology and respiratory medicine at the University of Manchester and as a member of the GOLD Science Committee, has led more than 300 clinical trials of new treatments for asthma and COPD as medical director of the Medicines Evaluation Unit. Singh sat down with HCPLive at the
Dave Singh, MD: The GOLD 2027 updates have included, I think, in many cases a refinement of the information that could better help the clinician. Maybe not a groundbreaking advance based on studies in the last year, but a chance to better describe areas that are common in clinical practice. So, for instance, mucus plugging. There’s been more information on that, and we’ve had a chance to put more into the document about the evidence and importance of mucus plugs.
There’s obviously been some adjustment to the language around definitions of early, mild, and pre-COPD [UNCLEAR — please review]. This often causes confusion, and one of the reasons we focused on that relates to clinical trials, because we often do clinical trials in patients at later stages in the natural history of the disease, and we really want to move to younger ages, people who are at higher risk, and try to do these studies before there’s too much lung damage. So I personally think that’s an important area for people to pay attention to: to diagnose people earlier and to encourage the generation of more evidence.
Dave Singh, MD: In terms of biologics, we, for example, have the data on astegolimab and tozorakimab. Those clinical trials are published, but those medicines don’t have a license. Tozorakimab has 2 positive phase 3 studies, and we hope it will get a license. But GOLD takes the approach of not putting them in the treatment algorithm until clinicians can prescribe them.
In terms of how clinicians should move forward, I think in your locality, you rely on your licensing procedure. So, for example, if tozorakimab becomes licensed in country X, then a clinician is able to use it according to the license.
Editor’s Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Singh had no relevant financial disclosures of note.
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