Is Dupixent (dupilumab) used to treat Chronic Obstructive Pulmonary Disease (COPD)?

Dupilumab for COPD: Current Evidence and Recommendations

Dupilumab (Dupixent) is FDA-approved for the treatment of inadequately controlled chronic obstructive pulmonary disease (COPD) with an eosinophilic phenotype, specifically as an add-on maintenance treatment in adult patients. 1

Indication and Patient Selection

Dupilumab is indicated for a specific subset of COPD patients with:

• Inadequately controlled COPD despite standard triple therapy (LAMA/LABA/ICS)
• Eosinophilic phenotype (blood eosinophil count ≥300 cells/μL)
• History of exacerbations despite optimal treatment

This targeted approach aligns with the growing understanding that COPD is heterogeneous, with different endotypes requiring personalized treatment approaches.

Efficacy Evidence

Recent high-quality evidence strongly supports dupilumab's efficacy in COPD patients with type 2 inflammation:

• Exacerbation reduction: Dupilumab reduced the annualized rate of moderate or severe exacerbations by 30% compared to placebo (rate ratio 0.70) 2
• Lung function improvement: Increased prebronchodilator FEV1 by 83 mL more than placebo at 12 weeks, with benefits sustained through 52 weeks 2
• Quality of life benefits: Improved St. George's Respiratory Questionnaire (SGRQ) scores by 3.4 points more than placebo 2
• Symptom reduction: Improved Evaluating Respiratory Symptoms in COPD (E-RS-COPD) scores by 1.1 points more than placebo 2

A pooled analysis of two phase 3 trials (BOREAS and NOTUS) confirmed these findings across a larger population of 1,874 patients, showing consistent benefits in exacerbation reduction (31.3% lower annualized rate) and prolonged time to first severe exacerbation 3.

Real-World Experience

Real-world data, though limited, supports clinical trial findings:

• 55% reduction in annualized exacerbation rates
• Decreased severe exacerbations
• Improved COPD assessment test scores
• Good tolerability with minimal side effects 4

Administration and Dosing

For COPD patients, dupilumab is administered as:

• Initial dose: 600 mg (two 300 mg injections)
• Maintenance: 300 mg subcutaneously every 2 weeks 1

Safety Considerations

Dupilumab has demonstrated a favorable safety profile in COPD patients:

• Similar rates of adverse events, serious adverse events, and treatment discontinuations compared to placebo 2
• No new safety signals specific to COPD patients 3

However, clinicians should be aware of potential adverse effects observed in other indications:

• Conjunctivitis and other ocular surface disorders (particularly in atopic dermatitis patients)
• Injection site reactions
• Rare cases of eosinophilia

Clinical Implications and Recommendations

1. Patient selection is critical: Target patients with:

   • Blood eosinophil count ≥300 cells/μL
   • Continued exacerbations despite triple therapy
   • No history of asthma or other pulmonary diseases associated with elevated eosinophils

2. Consider dupilumab when:

   • Standard triple therapy (LAMA/LABA/ICS) is inadequate
   • Patient has had ≥2 moderate or ≥1 severe exacerbation in the previous year
   • Quality of life is significantly impacted

3. Monitor for:

   • Reduction in exacerbation frequency and severity
   • Improvement in lung function and symptoms
   • Ocular side effects (refer to ophthalmology if needed)

4. Vaccination considerations:

   • Complete age-appropriate vaccinations prior to initiating treatment 1

Limitations and Considerations

• Dupilumab is not indicated for relief of acute bronchospasm 1
• Cost and need for repeated injections may limit accessibility for some patients 4
• Long-term efficacy and safety data beyond 52 weeks is still being collected

Dupilumab represents an important advancement in COPD management, offering a targeted biological therapy for patients with a specific inflammatory endotype who continue to experience exacerbations despite optimal standard therapy.