COPD Treatment & Medications
Sep 24, 2024
Dupilumab equally benefits COPD patients with type 2 inflammation whether they have emphysema or not. Photo by:
SAN FRANCISCO — Among patients with COPD and type 2 inflammation, investigator-reported emphysema did not change benefits seen with dupilumab, according to research presented at the American Thoracic Society International Conference.
"In the BOREAS and NOTUS trials, one of the inclusion criteria was the presence of cough and expectoration for 3 months in the previous year," Surya P. Bhatt, MD, professor in the division of pulmonary, allergy and critical care medicine at The University of Alabama at Birmingham, told Healio.
"The findings of this study indicate that the benefits of dupilumab in patients with COPD and type 2 inflammation are not confined to those with predominant airway disease but are also applicable to those with emphysema," Bhatt said.
Study Design
In this post hoc analysis of pooled BOREAS and NOTUS phase 3 trial data, Bhatt and colleagues assessed 1,874 adults with moderate to severe COPD and type 2 inflammation (blood eosinophil count ≥ 300 cells/μL) who were current or former smokers to determine if investigator-reported emphysema impacts benefits observed with dupilumab (Dupixent; Sanofi, Regeneron) in exacerbation rate and lung function.
As Healio previously reported, 300 mg dupilumab every 2 weeks for 52 weeks showed a decrease in the annualized moderate/severe exacerbation rate, a positive change in prebronchodilator FEV1 and safety in adults with moderate to severe COPD and type 2 inflammation at week 52 in a pooled analysis of BOREAS and NOTUS.
Notably, receiving dupilumab for 52 weeks also led to health-related quality of life improvement in the pooled population.
Researchers reported emphysema in 590 patients (31.5%), of which 289 received dupilumab and 301 received placebo.
Results
In both those with and without investigator-reported emphysema, the rate of annualized moderate/severe exacerbations dropped to a similar degree with dupilumab vs. placebo:
With emphysema: Relative risk (RR) = 0.66; 95% CI, 0.53-0.82
Without emphysema: RR = 0.7; 95% CI, 0.58-0.85
Between baseline and week 12, researchers additionally found a comparable level of improvement in prebronchodilator FEV1 with dupilumab vs. placebo when split into groups:
With emphysema: Least-squares mean difference, 83 mL; 95% CI, 35-131
Without emphysema: Least-squares mean difference, 83 mL; 95% CI, 45-120
Researchers noted that there was no significant difference in either outcome between the group with emphysema and the group without emphysema, signaling that dupilumab was beneficial regardless of whether the patient had investigator-reported emphysema.
Clinical Implications
"These findings are reassuring in that future studies of biologics targeting airway inflammation do not need to exclude individuals with emphysema," Bhatt told Healio.
Sources/Disclosures
Source:
Bhatt SP, et al. Dupilumab efficacy in patients with chronic obstructive pulmonary disease (COPD) and type 2 inflammation with and without emphysema. Presented at: American Thoracic Society International Conference; May 16-21, 2025; San Francisco.
Disclosures:
Sanofi and Regeneron Pharmaceuticals funded this study. Bhatt reports receiving grants from the NIH; research funds to his institute from Genentech, Nuvaira and Sanofi; consulting fees from Apreo, AstraZeneca, Boehringer Ingelheim, Chiesi, Genentech, GSK, Merck, Polarean, Sanofi, Regeneron and Verona Pharma; honorarium for CME from Horizon CME, Integritas Communications, Illuminate Health, Integrity CE and Medscape.
Topics: COPD, emphysema, inflammation, dupilumab, COPD exacerbation, lung function