Efficacy and Safety of Biologics Targeting Type 2 Inflammation in COPD: A Systematic Review and Network Meta-Analysis.

Purpose: This study aims to comparatively evaluate the efficacy and safety profiles of biologic agents targeting type 2 inflammation in COPD.

Methods: As of September 1, 2024, we identified and screened eight clinical studies evaluating biologic agents targeting type 2 inflammation for COPD treatment from multiple databases. Following data extraction, we conducted a network meta-analysis using R software to indirectly compare the efficacy and safety profiles of the five included biologic agents, incorporating visualization of the analytical results.

Results: In COPD patients with elevated eosinophil levels (peripheral blood eosinophil count ≥200 cells/μL), dupilumab demonstrated significant therapeutic efficacy by: (1) reducing the annualized rate of acute exacerbations (versus placebo: -0.44; 95% CI -0.77 to -0.10), (2) decreasing SGRQ total scores (versus placebo: -3.41; 95% CI -6.00 to -0.82), and (3) increasing pre-bronchodilator FEV1 (versus placebo: 0.06 L; 95% CI 0.00 to 0.12). Benralizumab also showed clinical benefits in reducing acute exacerbation rates (10 mg versus placebo: -0.21; 95% CI -0.39 to -0.04) and improving SGRQ scores (100 mg versus placebo: -1.70; 95% CI -3.35 to -0.04). Furthermore, all five biologic agents evaluated in this network meta-analysis exhibited favorable safety profiles.

Conclusion: This NMA demonstrates that both dupilumab and benralizumab show statistically significant efficacy in COPD management, particularly among patients with eosinophilic inflammation. And these biological agents maintain favorable safety profiles. Future research should focus on large-scale multicenter clinical trials, biomarker-based patient stratification, optimization of drug delivery regimens, and development of multi-target combination therapies.