Biologic Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
Background Despite limited breakthroughs in COPD pharmacotherapy, recent trials have shown promising results for biologics in COPD patients. However, robust evidence synthesis in this area is currently lacking.Methods We conducted a systematic review of MEDLINE, EMBASE, and Cochrane CENTRAL from inc...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2025-01-01
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| Series: | COPD |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/15412555.2025.2449889 |
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| author | Tyler Pitre Daniel Lupas Jasmine Mah Matthew Stanbrook Alina Blazer Dena Zeraatkar Terence Ho |
| author_facet | Tyler Pitre Daniel Lupas Jasmine Mah Matthew Stanbrook Alina Blazer Dena Zeraatkar Terence Ho |
| author_sort | Tyler Pitre |
| collection | DOAJ |
| description | Background Despite limited breakthroughs in COPD pharmacotherapy, recent trials have shown promising results for biologics in COPD patients. However, robust evidence synthesis in this area is currently lacking.Methods We conducted a systematic review of MEDLINE, EMBASE, and Cochrane CENTRAL from inception to July 17, 2024, to identify randomized trials of biologic medications in patients with COPD. We performed a random effects frequentist network meta-analysis and present the results using relative risk (RR) and 95% confidence intervals (CI). We used the GRADE framework to rate the certainty of the evidence. Outcomes of interest included exacerbations, change in FEV1, change in quality of life, and serious adverse events.Results Dupilumab reduced exacerbations as compared to placebo (RR 0.68 [95% CI 0.59 to 0.79]) (high certainty). Benralizumab (RR 0.89 [95% CI 0.78 to 1]), itepekimab (RR 0.81 [95% CI 0.61 to 1.07]) and tezepelumab (RR 0.83 [95% CI 0.61 to 1.12]) may reduce exacerbations as compared to placebo (all low certainty). Dupilumab probably reduced exacerbations more than mepolizumab (RR 0.74 [95% CI 0.62 to 0.89]) (moderate certainty). Dupilumab may reduce exacerbations more than tezepelumab (RR 0.82 [95% CI 1.14]) (low certainty). For all patients, no treatment improved FEV1 above the pre-specified minimal clinically important difference (MCID) of 0.1 L. Dupilumab probably has no meaningful effect on FEV1 compared to placebo (MD 0.07 [95% CI 0.02 to 0.13]) (moderate certainty). However, in the subgroup of patients with blood eosinophils ≥300/mcL, both tezepelumab (MD 0.15 [95% CI 0.05 to 0.26]) and dupilumab (MD 0.13 [95% CI 0.06 to 0.19]) probably improved FEV1 above the MCID.Conclusion Dupilumab is effective at improving patient-relevant outcomes in COPD with higher eosinophil levels. Other biological therapies, including tezepelumab, have no important effect on patient-relevant outcomes. |
| format | Article |
| id | doaj-art-1ac2e6fec36c415ab4fa254269893732 |
| institution | Kabale University |
| issn | 1541-2555 1541-2563 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | COPD |
| spelling | doaj-art-1ac2e6fec36c415ab4fa2542698937322025-01-29T09:35:36ZengTaylor & Francis GroupCOPD1541-25551541-25632025-01-0122110.1080/15412555.2025.2449889Biologic Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled TrialsTyler Pitre0Daniel Lupas1Jasmine Mah2Matthew Stanbrook3Alina Blazer4Dena Zeraatkar5Terence Ho6Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, CanadaSchulich School of Medicine and Dentistry, University of Western Ontario, London, ONDepartment of Medicine, Dalhousie University, Halifax, ON, CanadaDivision of Respirology, Department of Medicine, University of Toronto, Toronto, ON, CanadaDivision of Respirology, Department of Medicine, University of Toronto, Toronto, ON, CanadaHealth Research Methods Evidence and Impact, McMaster University, Hamilton, ON, CanadaDivision of Respirology, Department of Medicine, McMaster University, Hamilton, ON, CanadaBackground Despite limited breakthroughs in COPD pharmacotherapy, recent trials have shown promising results for biologics in COPD patients. However, robust evidence synthesis in this area is currently lacking.Methods We conducted a systematic review of MEDLINE, EMBASE, and Cochrane CENTRAL from inception to July 17, 2024, to identify randomized trials of biologic medications in patients with COPD. We performed a random effects frequentist network meta-analysis and present the results using relative risk (RR) and 95% confidence intervals (CI). We used the GRADE framework to rate the certainty of the evidence. Outcomes of interest included exacerbations, change in FEV1, change in quality of life, and serious adverse events.Results Dupilumab reduced exacerbations as compared to placebo (RR 0.68 [95% CI 0.59 to 0.79]) (high certainty). Benralizumab (RR 0.89 [95% CI 0.78 to 1]), itepekimab (RR 0.81 [95% CI 0.61 to 1.07]) and tezepelumab (RR 0.83 [95% CI 0.61 to 1.12]) may reduce exacerbations as compared to placebo (all low certainty). Dupilumab probably reduced exacerbations more than mepolizumab (RR 0.74 [95% CI 0.62 to 0.89]) (moderate certainty). Dupilumab may reduce exacerbations more than tezepelumab (RR 0.82 [95% CI 1.14]) (low certainty). For all patients, no treatment improved FEV1 above the pre-specified minimal clinically important difference (MCID) of 0.1 L. Dupilumab probably has no meaningful effect on FEV1 compared to placebo (MD 0.07 [95% CI 0.02 to 0.13]) (moderate certainty). However, in the subgroup of patients with blood eosinophils ≥300/mcL, both tezepelumab (MD 0.15 [95% CI 0.05 to 0.26]) and dupilumab (MD 0.13 [95% CI 0.06 to 0.19]) probably improved FEV1 above the MCID.Conclusion Dupilumab is effective at improving patient-relevant outcomes in COPD with higher eosinophil levels. Other biological therapies, including tezepelumab, have no important effect on patient-relevant outcomes.https://www.tandfonline.com/doi/10.1080/15412555.2025.2449889COPDbiologicsnetwork meta‑analysis |
| spellingShingle | Tyler Pitre Daniel Lupas Jasmine Mah Matthew Stanbrook Alina Blazer Dena Zeraatkar Terence Ho Biologic Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials COPD COPD biologics network meta‑analysis |
| title | Biologic Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials |
| title_full | Biologic Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials |
| title_fullStr | Biologic Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials |
| title_full_unstemmed | Biologic Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials |
| title_short | Biologic Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials |
| title_sort | biologic therapies for chronic obstructive pulmonary disease a systematic review and network meta analysis of randomized controlled trials |
| topic | COPD biologics network meta‑analysis |
| url | https://www.tandfonline.com/doi/10.1080/15412555.2025.2449889 |
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