From the Guidelines
Dupixent (dupilumab) is not a recommended treatment option for Chronic Obstructive Pulmonary Disease (COPD) based on current guidelines and evidence. The management of COPD typically involves a combination of bronchodilators, such as long-acting beta-agonists and anticholinergics, inhaled corticosteroids, pulmonary rehabilitation, and smoking cessation, as outlined in the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD 1.
Key Considerations for COPD Management
- The 2023 guideline promotes an evidence-informed approach that aligns proven effective treatments with spirometry, symptom burden, risk of future exacerbations, and mortality risk.
- Spirometry should not be used in isolation to assess disease severity, and a thorough clinical evaluation of the patient, including symptom burden and risk of exacerbations, is necessary.
- Treatments such as LAMA/LABA single inhaled dual therapy are preferred over ICS/LABA inhaled combination therapy, considering the additional improvements in lung function and the lower rates of adverse events.
Dupixent's Role in Respiratory Conditions
- Dupixent is approved for conditions like moderate-to-severe asthma, atopic dermatitis, and chronic rhinosinusitis with nasal polyps, but it has not been established as a standard treatment for COPD.
- Dupixent works by blocking interleukin-4 and interleukin-13 signaling, which is effective for type 2 inflammation seen in allergic conditions, but COPD is primarily characterized by neutrophilic inflammation and other mechanisms.
- While some research is exploring biologics like Dupixent for specific COPD phenotypes, particularly those with eosinophilic inflammation or asthma-COPD overlap, this remains investigational, as noted in the context of managing stable COPD 1.
Clinical Recommendations
- Patients with COPD should follow established treatment guidelines and consult with their healthcare provider about appropriate medication options based on their specific symptoms, disease severity, and comorbidities.
- The use of Dupixent or any other biologic for COPD should be approached with caution and considered only in the context of clinical trials or under the guidance of a specialist, given the current lack of evidence supporting its use in COPD management.
From the FDA Drug Label
DUPIXENT is indicated as an add-on maintenance treatment of adult patients with inadequately controlled chronic obstructive pulmonary disease (COPD) and an eosinophilic phenotype. Limitations of Use DUPIXENT is not indicated for the relief of acute bronchospasm.
Candidacy for Dupixent for COPD:
- Indicated for: Adult patients with inadequately controlled Chronic Obstructive Pulmonary Disease (COPD) and an eosinophilic phenotype.
- Not indicated for: Relief of acute bronchospasm.
- Key consideration: Patients must have an eosinophilic phenotype to be considered for Dupixent treatment. 2
From the Research
Dupixent (Dupilumab) for COPD
- Dupilumab is a fully human monoclonal antibody that blocks the shared receptor component for interleukin-4 and interleukin-13, key drivers of type 2 inflammation 3.
- In patients with COPD who have type 2 inflammation indicated by elevated blood eosinophil counts, dupilumab has been shown to reduce exacerbations and improve lung function and quality of life 3, 4.
Eligibility for Dupixent
- Patients with COPD who have a blood eosinophil count of at least 300 per microliter and an elevated exacerbation risk despite the use of standard triple therapy may be eligible for dupilumab treatment 3.
- Dupilumab has been shown to be effective in patients with COPD and type 2 inflammation, with or without investigator-reported emphysema 4.
Benefits of Dupixent for COPD
- Reduced annualized rate of moderate or severe exacerbations of COPD 3, 4.
- Improved lung function, as measured by prebronchodilator forced expiratory volume in 1 second (FEV1) 3, 4.
- Improved quality of life, as measured by the St. George's Respiratory Questionnaire (SGRQ) and the Evaluating Respiratory Symptoms in COPD (E-RS-COPD) 3.