Monoclonal Antibody Advances: Reshaping Asthma and COPD Management

Emerging monoclonal antibodies like depemokimab and tezepelumab are steering a new course in the treatment of severe asthma and COPD, emblematic of a broader shift toward precise and personalized interventions.

The introduction of monoclonal antibodies in respiratory care highlights a significant transformation in managing severe asthma. Randomized trials in severe eosinophilic asthma have shown that targeted biologics can reduce exacerbations and improve control, particularly with agents such as mepolizumab in selected phenotypes. These therapies, targeting specific inflammatory pathways, highlight progress in reducing exacerbations and oral corticosteroid exposure for selected patients, while inhaled corticosteroids remain foundational therapy in contemporary guidelines.

Depemokimab’s exploration in COPD remains investigational, with early conference-presented data focusing on outcomes such as exacerbation trends rather than established clinical benefit. Conference-presented, preliminary data have highlighted depemokimab’s potential signals in COPD, and these findings await confirmation in peer-reviewed, fully reported studies.

Tezepelumab has demonstrated reduced exacerbations in severe asthma and evidence of oral corticosteroid sparing in studied populations, with benefits varying by patient phenotype and inhaled corticosteroids remaining standard care. This therapy targets thymic stromal lymphopoietin (TSLP), an epithelial alarmin upstream of multiple inflammatory pathways, potentially optimizing asthma management without the steroid burden, as indicated by a recent presentation.

The WAYFINDER program provides real-world insights into tezepelumab use, suggesting reductions in exacerbations in routine practice while acknowledging variability across patient populations. Advocating for steroid-sparing strategies, it emphasizes how blocking upstream inflammatory signals can reshape treatment expectations.

Key Takeaways:

• Monoclonal antibodies are redefining asthma and COPD management through targeted therapy innovations.
• Depemokimab remains investigational in COPD, with preliminary, conference-presented signals that require peer-reviewed confirmation.
• Tezepelumab targets TSLP and has shown exacerbation reductions and some OCS-sparing effects in studied severe asthma populations.
• In selected severe asthma phenotypes, biologics such as anti–IL-5 and anti-TSLP agents reduce exacerbations and can lessen oral corticosteroid burden, while inhaled corticosteroids remain foundational.