Novel Maintenance Therapies for Chronic Obstructive Pulmonary Disorder

Abstract

Objective:

To summarize the Global Initiative for Chronic Obstructive Lung Disease (GOLD) updates and data for novel therapies/interventions.

Data sources:

Articles gathered from MEDLINE, Cochrane Reviews, and PubMed databases. Package inserts for novel agents were utilized. Search terms included chronic obstructive pulmonary disorder (COPD), inhaled corticosteroids (ICS), inhaled long-acting muscarinic antagonists (LAMA), inhaled long-acting beta-2 agonists (LABA), dupilumab, ensifentrine, icenticaftor, and itepekimab.

Study selection and data extraction:

English-language primary literature and review articles evaluated. GOLD guidelines from 2001 to 2025 were utilized.

Data synthesis:

Six meta-analyses and one randomized controlled trial (RCT) favor initial LAMA/LABA combination over monocomponent agents. Three RCTs note increased ICS efficacy with blood eosinophils >300 cells/µL. One meta-analysis and 8 RCTs address vaccinations, specifically RSV and pneumococcal. Novel medications ensifentrine, dupilumab, and icenticaftor each have 2 RCTs in patients with persistent symptoms despite optimized LAMA/LABA and ICS. Itepekimab is in phase 3 studies. The CAPTURE tool has 2 RCTs validating screening patients with unrecognized COPD.

Relevance to patient care and clinical practice:

Identification of notable changes to optimal COPD management, including LABA/LAMA therapy, judicious ICS use, updated vaccine recommendations, and potential roles for ensifentrine and dupilumab.

Conclusion and Relevance:

Evidence supports LABA/LAMA with nuanced use of ICS. Several novel therapies are approved or are being studied for patients suboptimally controlled. Pharmacists can assist in medication optimization and access; however, patient-specific factors like exacerbation history, blood eosinophils, and COPD endotype must be considered. Implementing early identification screening tools such as CAPTURE should factor into patient assessment.