The New England Journal of MedicineDupilumab for COPD with Type 2 Inflammation Indicated by Eosinophil Counts

Unraveling the Potential of Targeted Therapy

The monoclonal antibody dupilumab is showing promise in the management of patients with chronic obstructive pulmonary disease (COPD) characterized by type 2 inflammation, according to a recent phase 3 trial. This study showcases the impact of dupilumab on the rate of moderate or severe COPD exacerbations, as well as lung function and quality of life.

Study Design:

• Phase 3, double-blind, randomized trial.
• The study enrolled 939 patients, with 468 assigned to the dupilumab group and 471 to the placebo group.
• Participants were patients with COPD, having a blood eosinophil count of at least 300 per microliter and a high exacerbation risk despite using standard triple therapy.
• Participants were randomized to receive either dupilumab (300 mg) or placebo subcutaneously every two weeks.
• The primary endpoint was the annualized rate of moderate or severe COPD exacerbations.
• Key secondary endpoints included changes in prebronchodilator forced expiratory volume in 1 second (FEV1) and scores on St. George’s Respiratory Questionnaire (SGRQ) and Evaluating Respiratory Symptoms in COPD (E-RS–COPD).

Key Findings:

• The annualized rate of moderate or severe exacerbations was significantly lower in the dupilumab group than the placebo group.
• A considerable increase in prebronchodilator FEV1 from baseline to week 12 was observed with dupilumab treatment, and this was maintained through week 52.
• By week 52, the SGRQ and E-RS–COPD scores had improved more in the dupilumab group than the placebo group.
• The occurrence of adverse events leading to discontinuation, serious adverse events, and deaths were balanced in both groups.

Conclusion:

• The phase 3 trial demonstrates dupilumab’s potential in managing COPD with type 2 inflammation. It reduced exacerbation rates and improved lung function and quality of life, with a comparable safety profile to placebo. Further studies are needed to confirm long-term safety and efficacy.

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Did You Know?
Approximately 14% of COPD patients show an eosinophilic type of inflammation, which has been associated with a higher risk of exacerbations.