astegolimab (RG6149) / Amgen, Roche - LARVOL DELTA

Biologics in COPD: Current Status and Future Prospects. (PubMed, Tuberc Respir Dis (Seoul)) - "Subsequent Phase 3 trials have demonstrated substantial clinical benefits in defined patient subsets: dupilumab, which blocks interleukin (IL)-4 and IL-13 signaling, and mepolizumab, which targets IL-5, consistently reduced exacerbation frequency among patients with high blood eosinophil counts (≥300 cells/μL). In contrast, other biologics-benralizumab, tezepelumab, and IL-33/ST2 pathway inhibitors such as itepekimab, tozorakimab, and astegolimab-have shown variable efficacy, often dependent on biomarker profiles and patient characteristics. Together, these findings underscore the importance of precise patient stratification based on inflammatory endotypes. While biologics represent a major step forward for selected COPD populations, further research is required to clarify long-term outcomes, refine biomarker thresholds, and expand treatment options for non-eosinophilic COPD."

Journal • Chronic Obstructive Pulmonary Disease • Immunology • Inflammation • Pulmonary Disease • Respiratory Diseases • IL13 • IL33 • IL5

ARNASA: A Study to Evaluate Astegolimab in Participants With Chronic Obstructive Pulmonary Disease (clinicaltrials.gov) - P3 | N=1290 | Recruiting | Sponsor: Hoffmann-La Roche | Trial completion date: Mar 2027 ➔ Sep 2027

Trial completion date • Chronic Obstructive Pulmonary Disease • Immunology • Pulmonary Disease • Respiratory Diseases

YAP Regulates Microglial Anti-Inflammatory Responses and Alleviates Cognitive Impairment Through the IL-33/ST2 Pathway after Traumatic Brain Injury. (PubMed, J Neurotrauma) - "These beneficial effects were effectively reversed by the administration of astegolimab, confirming the specificity of the YAP/IL-33/ST2 mechanism. Above all, we found that YAP produced by astrocytes regulates microglial anti-inflammatory responses through the IL-33/ST2 pathway, thereby improving cognitive function after TBI."

Journal • Alzheimer's Disease • CNS Disorders • Cognitive Disorders • Inflammation • Vascular Neurology • IL33 • MRC1

Randomised, placebo-controlled trial of astegolimab for COPD with frequent exacerbations: ALIENTO (BTS WM 2025) - P2 | "Adverse events were balanced between treatment arms. Download figure Open in new tab Download powerpoint Abstract S1 Figure 1 Conclusions Astegolimab Q2W decreased annualised COPD exacerbation rate by 15% ( P =0.0494) vs placebo in the overall ALIENTO population (irrespective of smoking status or EOS level), with trends for improvement in some other clinical outcomes."

Clinical • Chronic Obstructive Pulmonary Disease • Immunology • Respiratory Diseases

Safety and tolerability of astegolimab, an anti-ST2 monoclonal antibody: a narrative review. (PubMed, Respir Res) - "Astegolimab did not increase the risk of infection or major adverse cardiac events. Ongoing Phase IIb and Phase III trials of astegolimab in patients with COPD who have a history of frequent acute exacerbation(s) of COPD will provide a future opportunity to confirm the safety profile of astegolimab."

Journal • Review • Asthma • Atopic Dermatitis • Cardiovascular • Chronic Obstructive Pulmonary Disease • Dermatitis • Dermatology • Immunology • Infectious Disease • Inflammation • Novel Coronavirus Disease • Pneumonia • Pulmonary Disease • Respiratory Diseases • IL33

Astegolimab: NME submission in US for COPD in 2025 (Roche) - Q3 2025 Results: Regulatory submission in EU for COPD in 2025

EMA filing • FDA filing • Chronic Obstructive Pulmonary Disease • Immunology

Safety, Pharmacokinetics, and Immunogenicity of Astegolimab, an Anti-ST2 Monoclonal Antibody, in Randomized, Phase I Clinical Studies. (PubMed, Clin Transl Sci) - P1 | "Astegolimab was well tolerated in these Phase I studies with no safety concerns identified. Thus, further assessment of astegolimab in targeted patient populations was justified; the Phase IIb ALIENTO and Phase III ARNASA trials in patients with chronic obstructive pulmonary disease are ongoing."

Clinical • Journal • P1 data • PK/PD data • Asthma • Chronic Obstructive Pulmonary Disease • Immunology • Inflammation • Pulmonary Disease • Respiratory Diseases • IL33

Late Breaking Abstract - AI-guided biparatopic TSLP nanobody based TSLP/IL-4Rα and TSLP/ST2 bispecific antibodies for chronic respiratory diseases (ERS 2025) - " Epitope analysis validated an AI-guided biparatopic TSLP nanobody, exhibiting superior in vitro activity approximately 200-fold better than Tezepelumab, and also surpassing GSK5784283...It exhibited synergistic TARC inhibition in PBMCs and demonstrated superior anti-inflammatory effects in an OVA- induced asthma mouse model compared to Tezepelumab and Dupilumab...Similarly, the TSLP/ST2 BiAb matched the TSLP activity of the biparatopic nanobody and outperformed Astegolimab in ST2 activity of 10 times. The BiAbs derived from a best-in-class biparatopic TSLP nanobody hold significant promise for the treatment of asthma and COPD."

Late-breaking abstract • Asthma • Chronic Obstructive Pulmonary Disease • Immunology • Respiratory Diseases • CRLF2 • IL7R • TSLP

RCT Abstract - ARNASA: A Phase III randomised, double-blind, placebo-controlled trial of astegolimab for COPD with frequent exacerbations (ERS 2025) - No abstract available

Clinical • Late-breaking abstract • P3 data • Chronic Obstructive Pulmonary Disease • Immunology • Respiratory Diseases

Late Breaking Abstract - Randomised, placebo-controlled trial of astegolimab for COPD with frequent exacerbations: ALIENTO (ERS 2025) - No abstract available

Clinical • Late-breaking abstract • Chronic Obstructive Pulmonary Disease • Immunology • Respiratory Diseases

Tozorakimab exerts distinct dual pharmacology to reduce COPD epithelial remodelling (ERS 2025) - " Tozorakimab was the only anti-IL-33/ST2 mAb, including itepekimab and astegolimab, that reduced mucus secretion in differentiated, bronchial COPD ALI cultures ( Table ). Of the anti-IL-33/ST2 mAbs tested, only tozorakimab demonstrated the ability to reduce epithelial remodelling and promote repair. Tozorakimab is under clinical investigation in COPD and other respiratory diseases."

Chronic Obstructive Pulmonary Disease • Immunology • Respiratory Diseases • IL33 • MUC5AC

Patient experiences during COPD care using biologics: a scoping review (ERS 2025) - "Evidence of harm (cancer and pneumonia) was observed in patients treated with infliximab...Safety outcomes found moderate certainty for dupilumab, mepolizumab and benralizumab... Careful patient selection and identification of COPD phenotypes and endotypes are crucial to benefit from Bs."

Clinical • Review • Chronic Obstructive Pulmonary Disease • Immunology • Infectious Disease • Pneumonia • Respiratory Diseases

Comparable pharmacokinetics (PK), safety and tolerability of astegolimab administered subcutaneously (SC) via abdomen, thigh or upper arm: a Phase I, single-dose study (ERS 2025) - P1 | "PK of single-dose astegolimab in UA or TH are comparable to AB, with reassuring immunogenicity, safety and tolerability, supporting the use of alternative injection sites for astegolimab administration."

Clinical • PK/PD data • Chronic Obstructive Pulmonary Disease • Immunology • Pulmonary Disease • Respiratory Diseases

Multi-Criteria Decision Analysis of Biologics in Chronic Obstructive Pulmonary Disease. (PubMed, Int J Chron Obstruct Pulmon Dis) - "Dupilumab (anti-IL-4Rα) demonstrated the most robust efficacy in eosinophilic COPD, with consistent reductions in exacerbation rates and improvements in FEV1, supported by high trial quality. Mepolizumab and benralizumab (anti-IL-5/IL-5R) showed moderate efficacy in biomarker-enriched populations. Anti-alarmins, specifically tozorakimab (anti-IL-33), itepekimab (anti-IL-33/IL-1RL1), astegolimab (anti-ST2), and tezepelumab (anti-TSLP), showed mixed results, with modest lung function gains but largely non-significant effects on exacerbation rates. Agents targeting non-T2 pathways, including infliximab (anti-TNF-α), canakinumab (anti-IL-1β), MEDI8968 (anti-IL-1R1), CNTO6785 (anti-IL-17A), and ABX-IL8 (anti-IL-8), consistently failed to demonstrate clinical efficacy, often due to small sample sizes, early-phase design, and lack of biomarker stratification. Biologics targeting T2 inflammation offer therapeutic promise in eosinophilic COPD when guided by biomarkers...."

Journal • Chronic Obstructive Pulmonary Disease • Immunology • Inflammation • Pulmonary Disease • Respiratory Diseases • CXCL8 • IL17A • IL1B • IL1R1 • IL33 • IL5

Therapeutic application of cytokine antagonists in chronic obstructive pulmonary disease (PubMed, Zhonghua Jie He He Hu Xi Za Zhi) - "Biologics targeting type 2 inflammation, such as Tezepelumab (targeting thymic stromal lymphopoietin, TSLP), Itepekimab and Astegolimab (targeting IL-33), and Dupilumab (targeting IL-4/IL-13), have demonstrated potential in clinical trials to improve outcomes and enhance the quality of life for COPD patients. This article systematically outlines the molecular mechanisms of type 2 inflammation in COPD and the progress in targeted therapies. It emphasizes that the clinical translation of biologics must be guided by precision medicine, integrating mechanistic research with real-world evidence to advance COPD treatment towards "individualized intervention." Future research needs to further elucidate the interactions between type 2 and non-type 2 inflammatory phenotypes and to explore combination therapeutic strategies, in order to provide more comprehensive solutions for the prevention and management of COPD."

Journal • Review • Chronic Obstructive Pulmonary Disease • Immunology • Inflammation • Pulmonary Disease • Respiratory Diseases • IL13 • IL33 • IL4 • IL5 • TSLP

Breaking new ground biologic in COPD: Beyond the usual puff (MTS 2025) - "The most significant advancement is the FDA approval of dupilumab, an anti-IL-4/IL-13 monoclonal antibody, for COPD patients with type 2 inflammation...Other biologics under investigation include anti-IL-5 agents like mepolizumab and benralizumab, which target eosinophilic inflammation, and anti-alarmins such as itepekimab, astegolimab, tozorakimab and tezepelumab, which interfere with epithelial-derived cytokines like IL-33 and TSLP...Biomarkers such as blood eosinophil count, FeNO, and mucus scoring techniques (CT-based and bronchoscopic) are becoming essential tools in identifying candidates for biologic therapy. This biologic revolution signals a departure from standard inhaler-based regimens, offering a new frontier in COPD management where therapy is matched to inflammatory phenotype—marking a bold step forward in precision respiratory medicine."

Chronic Obstructive Pulmonary Disease • Immunology • Inflammation • Respiratory Diseases • IL13 • IL33 • IL4 • IL5 • TSLP

Electroacupuncture Protects Against Post-stroke Cognitive Impairment by Promoting an IL-33/ST2 Axis-Mediated Microglia M2 Polarization. (PubMed, Neurochem Res) - "To investigate the role of the Interleukin-33 (IL-33)/Interleukin 1 Receptor-Like 1 (ST2) signaling pathway in EA's therapeutic effects, the ST2 inhibitor Astegolimab (Anti-ST2) was stereotactically injected into the lateral ventricle prior to EA intervention...However, blockade of the IL-33/ST2 pathway with Anti-ST2 diminished the therapeutic benefits of EA, aggravated white matter injury and cerebral infarct volume, and amplified the inflammatory response. EA facilitates microglial polarization toward the M2 phenotype via the IL-33/ST2 signaling pathway, strengthens the structural integrity of cerebral white matter, and promotes neurological recovery after ischemic stroke."

Journal • Alzheimer's Disease • Cardiovascular • Cognitive Disorders • Inflammation • Ischemic stroke • IL10 • IL1B • IL33 • IL4 • IL6 • TNFA

A Study to Evaluate the Efficacy and Safety of Astegolimab in Participants With Chronic Obstructive Pulmonary Disease (clinicaltrials.gov) - P2 | N=1334 | Completed | Sponsor: Genentech, Inc. | Active, not recruiting ➔ Completed

Trial completion • Chronic Obstructive Pulmonary Disease • Immunology • Pulmonary Disease • Respiratory Diseases

Genentech Provides Update on Astegolimab in Chronic Obstructive Pulmonary Disease (Businesswire) - P3 | N=1,290 | ARNASA (NCT05595642) | Sponsor: Hoffmann-La Roche | "...the Phase III ARNASA study did not meet its primary endpoint of a statistically significant reduction in the AER, demonstrating a numerical 14.5% reduction at 52 weeks when astegolimab was given every two weeks. The results were generally consistent across secondary endpoints...The total number of exacerbations was lower than prospectively anticipated [in the trial]....The safety profile of astegolimab was consistent with previously reported data, with no new safety signals identified."

P3 data: top line • Chronic Obstructive Pulmonary Disease

Genentech Provides Update on Astegolimab in Chronic Obstructive Pulmonary Disease (Businesswire) - P2b | N= 1,334 | ALIENTO (NCT05037929) | Sponsor: Genentech, Inc | "Genentech...announced today topline results...The pivotal Phase IIb ALIENTO study met its primary endpoint and showed that astegolimab reduced the annualized exacerbation rate (AER) by a statistically significant 15.4% at 52 weeks, when given every two weeks...The results were generally consistent across secondary endpoints; The total number of exacerbations was lower than prospectively anticipated [in the trial]."

P2b data • Chronic Obstructive Pulmonary Disease

Advancements in Biologic Therapies for Pediatric Asthma: Emerging Therapies and Future Directions. (PubMed, Cureus) - "Biologics such as omalizumab, mepolizumab, dupilumab, benralizumab, and tezepelumab have been reported to reduce severe asthma exacerbations, with reassuring short-term safety profiles among children and adolescents (pediatrics)...Literature review also highlights the emerging treatment regimens for non-T2 endotypes, such as tezepelumab, ecleralimab, and astegolimab (IL-33), which influence both T2 and non-T2 pathways...Ultimately, the continued advancement and strategic implementation of biologic therapies hold the potential to revolutionize the management of severe pediatric asthma, leading to reduced exacerbations and corticosteroid use, improved quality of life, and more precise treatment strategies tailored to individual patient profiles. Moreover, future research should continue to address the challenges related to long-term safety, cost-effectiveness, and equitable access, which are vital to realizing the true potential of biologic therapies in treating pediatric..."

Journal • Review • Asthma • Immunology • Inflammation • Pediatrics • Pulmonary Disease • Respiratory Diseases • IL33

Structural Basis for Inhibition of IL-33 Induced ST2 Activation by Astegolimab (ATS 2025) - "Biochemical and biophysical studies using recombinantly generated proteins show that astegolimab prevents IL33 from binding to ST2 in solution. A 2.6 Å cryo-EM structure of ST2 bound to the Fab fragment from astegolimab reveals that astegolimab binds to the IL33-binding interface on ST2, directly competes with IL33 binding, thereby prevents formation of the active signaling complex necessary for ST2 activation."

Chronic Obstructive Pulmonary Disease • Immunology • Pulmonary Disease • Respiratory Diseases • IL1RAP • IL33

Serum Soluble ST2 (sST2) Is Associated With Chronic Obstructive Pulmonary Disease (COPD) Exacerbations and Enhanced Treatment Response to Astegolimab (Anti-ST2) (ATS 2025) - P2, P2b, P3 | "In the LEUKO study (NCT00493974), hospitalized COPD patients experiencing acute exacerbations received zileuton to assess the effect on hospital stay length. Our post-hoc analyses indicate sST2 levels: 1) are prognostic for exacerbations in placebo-treated COPD subjects, when measured at baseline, and 2) are elevated at the time of hospitalized exacerbation, suggesting NFκB signaling cytokines, such as IL-33, underlie COPD exacerbations. Notably, both COPD and asthma subjects with higher levels of sST2 at baseline derived greater astegolimab AERR treatment benefit."

Asthma • Chronic Obstructive Pulmonary Disease • Immunology • Inflammation • Pulmonary Disease • Respiratory Diseases • IL33 • ST2

Biologic Therapies for Severe Asthma: Current Insights and Future Directions. (PubMed, J Clin Med) - "The current biologics for severe asthma treatment include omalizumab (anti-IgE), mepolizumab and reslizumab (anti-IL-5), benralizumab (anti-IL-5 receptor), dupilumab (anti-IL-4/IL-13), and tezepelumab (anti-TSLP)...Depemokimab is an ultra-long-acting anti-IL-5 antibody with promising results in phase III trials as a twice-yearly biologic for T2-high asthma. Verekitug follows a similar dosing concept, targeting TSLP, but is still undergoing phase II trials. Itepekimab and astegolimab are two anti-IL-33 antibodies that could have a role in the future treatment of severe asthma. Tezepelumab is in a phase III clinical trial for CRSwNP. Besides new drugs, there is still a need for major research into biologics in severe asthma cases, namely with comparative studies, better biomarkers for predicting response, and the determination of optimal treatment duration."

Journal • Review • Asthma • Chronic Rhinosinusitis With Nasal Polyps • Immunology • Inflammation • Nasal Polyps • Otorhinolaryngology • Pulmonary Disease • Respiratory Diseases • Sinusitis • IL13 • IL33 • IL4 • IL5

Astegolimab: NME submission in US for COPD in 2025 (Roche) - Q1 2025 Results: Regulatory submission in EU for COPD in 2025

EMA filing • FDA filing • Chronic Obstructive Pulmonary Disease • Immunology