The phase 3 MIRANDA trial showed that add-on tozorakimab significantly reduced moderate-to-severe exacerbations in patients with chronic obstructive pulmonary disease (COPD), particularly in former smokers already on inhaled therapy. As an IL-33–targeting monoclonal antibody, it acts on upstream inflammatory pathways (Th1/Th2) and epithelial dysfunction, highlighting its potential as a novel treatment strategy for high-risk COPD patients. In MIRANDA, patients received tozorakimab 300mg or placebo on top of standard of care once every two weeks.1 The trial enrolled patients with COPD still experiencing moderate-to-severe exacerbations while on inhaled standard of care. Even when on inhaled standard of care, more than 50% of patients experience exacerbations, putting them at an increased risk of cardiopulmonary events and mortality. Tozorakimab is also being studied in a Phase III trial for severe viral lower respiratory tract disease and in a Phase II trial in asthma.