Biologics for COPD: Dupixent, Nucala, and New Treatments in Development

If you’re living with chronic obstructive pulmonary disease (COPD), it’s normal to feel frustrated. Symptoms like shortness of breath, coughing, and wheezing can seemingly come out of nowhere. And even if you’re already using inhalers or other treatments, they don’t always do the trick — especially if flare-ups keep coming back.

That’s where newer medications, called biologics, might come in. These are different from traditional COPD treatments. Instead of opening your airways like inhalers do, these injectable medications target specific parts of your immune system that may be causing inflammation in your lungs.

Dupixent (dupilumab) and Nucala (mepolizumab) are the two biologics that are currently FDA approved for COPD. They aren’t for everyone. But for people with certain types of COPD, they can make a big difference.

Here, we’ll cover six ways that Dupixent and Nucala stack up for COPD. We’ll also cover what biologics may be following in their footsteps.

1. Dupixent and Nucala have distinct uses

Dupixent and Nucala are both approved to treat COPD with an eosinophilic phenotype. This means they’re intended for people who have higher levels of eosinophils — a type of white blood cell tied to inflammation in the lungs. Here’s how they help:

• Dupixent is approved for adults with COPD and type 2 inflammation, which often — but not always — includes elevated eosinophils. It targets two specific inflammatory pathways linked to mucus production, airway narrowing, and flare-ups.

• Nucala is also approved for adults with eosinophilic COPD. It works by targeting one protein that helps your body make and activate eosinophils.

Before recommending either medication, your healthcare team will likely order a blood test to check your eosinophil levels. They may also look at your history of COPD flare-ups, current medications, and other health conditions to figure out which option may be a better fit.

In addition to COPD, Dupixent is approved to treat:

• Eosinophilic asthma

• Atopic dermatitis (eczema)

• Chronic rhinosinusitis with nasal polyps

• Eosinophilic esophagitis, a form of inflammation in the esophagus

• Prurigo nodularis, a skin condition that causes itchy bumps

• Chronic spontaneous urticaria (hives)

• Bullous pemphigoid, a blistering skin condition

EXPERT PICKS: WHAT TO READ NEXT

• A treatment breakthrough: Dupixent (dupilumab) was the first FDA-approved biologic for COPD, or chronic obstructive pulmonary disease. Here’s why its 2024 approval was notable.

• Affordability and access: Inhalers don’t have to be pricey. This GoodRx guide details different ways to save on COPD inhalers.

• Asthma biologics: Dupixent and Nucala (mepolizumab) can also treat asthma — not just COPD. Read on to see what other biologics are available to treat asthma.

Nucala is also approved for:

• Eosinophilic asthma

• Chronic rhinosinusitis with nasal polyps

• Eosinophilic granulomatosis with polyangiitis, a condition that causes inflamed blood vessels

• Hypereosinophilic syndrome

If you have one of these conditions in addition to COPD, you may be able to treat both conditions with one medication.

2. Dupixent and Nucala work in slightly different ways

Biologics work by targeting parts of your immune system that lead to inflammation. Dupixent and Nucala each work on different parts of that system:

• Dupixent blocks two proteins: interleukin-4 (IL-4) and interleukin-13 (IL-13). These proteins play a role in type 2 inflammation and may trigger airway swelling and mucus buildup in people with COPD.

• Nucala blocks a protein called interleukin-5 (IL-5). IL-5 helps the body make eosinophils. By blocking it, Nucala lowers eosinophil levels in the blood, which may reduce inflammation in the lungs.

Because of how they work, these medications aren’t quick fixes. It may take several weeks or months to feel their full effects. Once their effects do set in, Dupixent and Nucala can help reduce flare-ups and improve lung function. Neither one treats active COPD exacerbations.

3. Dupixent and Nucala are used at similar points in your COPD journey

Biologic medications aren’t first-choice treatments for COPD. You’ll likely start with inhaled options such as long-acting beta agonists (LABAs) and long-acting muscarinic antagonists (LAMAs).

If you’ve had two or more COPD flare-ups in the past year — despite using those inhalers — your healthcare team may consider prescribing you a biologic. They may also recommend one if you’ve been hospitalized for COPD.

Keep in mind: Dupixent and Nucala are add-on treatments. They’re not replacements for your inhalers. You’ll continue using your other medications with a biologic, unless your healthcare team tells you otherwise.

4. Dupixent and Nucala are administered on different schedules

Dupixent and Nucala are both given as subcutaneous (under-the-skin) injections. But how they’re given — and how often — varies slightly:

• Dupixent is usually injected every 2 weeks for COPD. Most people can self-inject at home after being trained by a healthcare professional.

• Nucala is typically injected every 4 weeks for COPD. It may be given at a clinic or at home.

Both medications come in prefilled syringes and injection pens to make administration easier. If you’re nervous about giving yourself a shot, ask your prescriber or pharmacist for additional training and injection tips.

5. Each medication has risks and side effects to consider

As with all medications, there’s a chance of side effects with COPD biologics. Some are mild and go away on their own, but others may require medical attention.

Common Dupixent side effects include:

• Injection site reactions, such as redness, swelling, and pain

• Eye problems, such as redness or itching

• Back or joint pain

• Sore throat, runny nose, and other cold-like symptoms

• Headaches

• Diarrhea

With Nucala, common side effects include:

• Injection site reactions

• Back pain

• Diarrhea

• Cough

• Headaches

• Fatigue

Allergic reactions are possible, albeit rare, with both medications. Possible symptoms of a serious reaction (such as anaphylaxis) include trouble breathing, swelling of the face or throat, and sudden dizziness. Call 911 or go to the nearest ER if you develop any of these symptoms.

These medications carry other risks. If you experience any new or worsening symptoms after starting a biologic, contact your healthcare team as soon as possible.

6. Interactions aren’t a common concern, but still use caution

Dupixent and Nucala aren’t known to directly interact with other medications. This is good news if you’re taking several other prescription or over-the-counter (OTC) products.

Because these medications affect your immune system, certain precautions are still important. Your healthcare team will want to make sure your body can tolerate the medication and that it won’t interfere with how your immune system fights infections or responds to vaccines.

Your healthcare team may adjust your treatment plan or delay your new prescription if:

• You have an active infection or a history of frequent infections. Since biologics can change how your immune system works, they may increase your risk of certain infections or make it harder for your body to fight them off.

• You’re planning to get certain vaccines. Live vaccines aren’t usually recommended for people receiving a biologic. Receiving one might lead to an accidental infection. So your prescriber may suggest getting caught up on vaccinations before starting a COPD biologic.

Do your best to be open about your full medical history with your healthcare team if you’re starting Dupixent, Nucala, or a similar medication. Doing so can help you stay ahead of any potential issues.

Other biologics for COPD are in development, too

As of August 2025, Dupixent and Nucala are the only FDA-approved biologics for COPD. But they likely won’t be the only options for long. Researchers are studying several other biologics for COPD — especially in people with high levels of inflammation or eosinophils.

These are some of the main options being investigated in clinical trials:

• Fasenra (benralizumab): Already approved for severe eosinophilic asthma, Fasenra works by reducing eosinophils — similar to Nucala. Clinical trials are exploring whether it can also help with COPD flare-ups in people with high eosinophil counts.

• Tezspire (tezepelumab): Tezspire is an approved asthma biologic that blocks a protein called thymic stromal lymphopoietin (TSLP). TSLP normally helps start the inflammatory process. Researchers are now testing the medication in people with either eosinophilic or noneosinophilic COPD, making it a promising option for treating more types of the condition.

• Itepekimab: This experimental biologic targets interleukin-33 (IL-33), another protein involved in lung inflammation. While it hasn’t been approved for any condition yet, early studies suggest it may help reduce COPD flare-ups among former smokers.

• Depemokimab: Like Nucala and Fasenra, this biologic targets IL-5 to reduce eosinophils. It’s currently in development for asthma and other eosinophil-related conditions, and it may also be useful for people with COPD and high eosinophil levels.

• Astegolimab: This medication targets the ST2 receptor, which is involved in the body’s response to IL-33. It’s still being studied, but early data shows it might help reduce lung inflammation in people with COPD. In a recent study, it fell short of expectations, though.

These medications are still in the research and development phase, and it may take a few years before we know how effective they are — or if they’ll be approved at all. For now, they provide hope that more COPD treatment options are on the way.

How to save on Dupixent and Nucala

Dupixent and Nucala are available as reference (“brand-name”) medications. Neither one is currently available as a lower-cost biosimilar. But GoodRx can help you navigate ways to save on your prescription:

• Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Dupixent’s price is as little as $0 per prescription with a copay savings card from the manufacturer. Nucala is also available for as little as $0 per prescription with a copay savings card.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may qualify to receive Dupixent or Nucala at no cost through a patient assistance program.

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Written by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Austin Ulrich, PharmD, BCACP

​​Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. Ulrich’s experience includes direct patient care in hospital and community pharmacies.

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