New drugs under development for COPD

ABSTRACT

Introduction

Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic bronchitis, emphysema, and remodeling. Its prevalence is increasing worldwide; however, there are few effective therapies, and none of the treatments currently available prevent the progression of the disease or target all of the hallmark features. The development and progression of COPD are heterogeneous, which has hampered the development of new therapies.

Areas covered

In this review, we cover the emergence of the improvement of existing classes of drugs including glucocorticoids, β2-adrenoceptor agonists, phosphodiesterase inhibitors, PDE4 selective inhibitors, PDE3/PDE4 inhibitors, protease inhibitors, recombinant α1-antitrypsin and neutrophil elastase inhibitors. We also highlight new compounds that target recently identified mechanisms of COPD, new dual-action muscarinic antagonists, and β2-agonists, kinase inhibitors, cytokine modifiers, chemokines modifiers, NF-κB inhibitors, senolytics, antioxidants, inhaled antiviral agents, anti-fibrotic compounds, and compounds stimulating lung regeneration.

Expert opinion

Given the myriad of potential therapeutic avenues that can be pursued, careful consideration of the phenotypes/endotypes of COPD patients will be important for personalized treatment options in the future, and a full understanding of disease mechanisms in patient subsets will ensure these emerging therapies are targeted appropriately.

KEYWORDS:

• COPD
• exacerbation
• pathogenesis
• new drugs
• therapy

Article highlights

• Current therapies only treat some of the symptoms, and no treatments reverse the hallmark features of disease.

• Improving existing classes of drugs has resulted in many new clinical trials for different classes of glucocorticoids, β2-adrenoceptor agonists, phosphodiesterase inhibitors, PDE4 selective inhibitors, PDE3/PDE4 inhibitors, protease inhibitors, recombinant a1-antitrypsin and neutrophil elastase inhibitors.

• Many pathways involved in the development and progression of COPD have been identified, such as dual-action muscarinic antagonists and β2-agonists, kinase inhibitors, cytokine modifiers, chemokines modifier, NF-κB inhibitors, senolytics, antioxidants, inhaled antiviral agents, anti-fibrotic compounds and compounds stimulating lung regeneration, with new drugs under development for targeting these pathways.

• Recent advances in ‘omic’ technologies has allowed for a new depth of understanding of disease but also highlighted the heterogeneity of COPD patients.

Declaration of interest

PM Hansbro is funded by a Fellowship and grants from the National Health and Medical Research Council (NHMRC) of Australia (1,175,134) and by the University of Technology Sydney. Gaetano Caramori has received unrestricted educational and/or research grants and/or Lecture fees and/or grants for travel and accommodation to participate to scientific meetings from: Astra Zeneca, Alfasigma (Biofutura has merged inside it), Boehringer-Ingelheim, Chiesi Farmaceutici, Enfarma, GSK, Menarini Group, University of Messina, Italy. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.