From the Guidelines
Dupixent (dupilumab) is indicated for COPD patients with an eosinophil count of 300 cells/μL or higher, as this threshold identifies patients with type 2 inflammatory COPD who are most likely to benefit from this biologic therapy. This treatment works by blocking interleukin-4 and interleukin-13 signaling, which are key drivers of type 2 inflammation in the airways. For COPD patients meeting this eosinophil criterion, the recommended dosage is 300 mg administered subcutaneously every two weeks.
Key Points to Consider
- The eosinophil count is a biomarker for patient selection, as patients with lower eosinophil counts may not experience the same degree of benefit from Dupixent therapy 1.
- Regular monitoring of clinical response and eosinophil levels during treatment may help guide ongoing therapy decisions.
- It is essential to perform a complete blood count with differential before initiating therapy to confirm the eosinophil level.
- The use of blood eosinophil counts as a biomarker for exacerbation risk and ICS effects in COPD patients requires further validation through prospective trials 1.
- Glucocorticoids, such as prednisone, may be less efficacious in treating exacerbations in patients with lower blood eosinophil levels 1.
Treatment Considerations
- Dupixent has been shown to reduce moderate or severe acute exacerbations of COPD by approximately 30% in clinical trials.
- The treatment effect of ICS/LABA versus LABA on exacerbations was greater in patients with higher blood eosinophil counts 1.
From the FDA Drug Label
In subjects with COPD (BOREAS and NOTUS), the mean and median increases in blood eosinophils from baseline to Week 8 were 60 and 0 cells/mcL, respectively. In the trials for the COPD indication, treatment-emergent eosinophilia (≥500 cells/mcL) was higher in DUPIXENT (41.7%) than in the placebo group (39.4%); none of the cases were associated with clinical symptoms, and treatment-emergent eosinophilia (≥1000 cells/mcL) was higher in DUPIXENT (13.6%) than in the placebo group (8. 1%).
The eosinophil count for Dupixent (dupilumab) in Chronic Obstructive Pulmonary Disease (COPD) indication is as follows:
- Mean increase in blood eosinophils from baseline to Week 8: 60 cells/mcL
- Median increase in blood eosinophils from baseline to Week 8: 0 cells/mcL
- Treatment-emergent eosinophilia (≥500 cells/mcL): 41.7% in DUPIXENT group and 39.4% in placebo group
- Treatment-emergent eosinophilia (≥1000 cells/mcL): 13.6% in DUPIXENT group and 8.1% in placebo group 2
From the Research
Eosinophil Count for Dupixent (Dupilumab) in COPD Indication
- The eosinophil count for Dupixent (dupilumab) in Chronic Obstructive Pulmonary Disease (COPD) indication is ≥300 cells/μL 3, 4, 5
- Patients with COPD and type 2 inflammation, as indicated by elevated blood eosinophil counts, who received dupilumab had fewer exacerbations, better lung function, and less severe respiratory symptoms than those who received placebo 3, 5
- The annualized rate of moderate or severe exacerbations was reduced by 29-31% in patients with COPD and type 2 inflammation who received dupilumab compared to placebo 6
- Dupilumab efficacy was similar in patients with COPD and type 2 inflammation, with or without investigator-reported emphysema 6
- A clear correlation was demonstrated between the effect of continued inhaled corticosteroid (ICS) treatment and increasing eosinophil count, with ICS treatment seeming beneficial for patients with eosinophil counts above 150 cells/μL 7