Dupilumab reduced emergency visits and admissions in eosinophilic COPD by 38%

Design

Pooled analysis of two phase 3 double-blind RCTs

Population

1,874 adults with COPD and blood eosinophils of 300 cells/µL or more

Primary outcome

ED visits or hospital admissions; systemic steroid use

Effect

Rate ratio 0.62 (0.43 to 0.90); first event HR 0.55 (0.38 to 0.78)

A pooled analysis of the BOREAS and NOTUS phase 3 double-blind trials in the American Journal of Respiratory and Critical Care Medicine (September 2026) included 1,874 adults aged 40 to 85 with COPD, moderate to severe airflow limitation and blood eosinophils of 300 cells/µL or more, randomised to dupilumab 300 mg or placebo for 52 weeks.

Dupilumab reduced emergency visits or hospital admissions by 38% (rate ratio 0.62, 95% CI 0.43 to 0.90) and the risk of a first such event by 45% (HR 0.55, 0.38 to 0.78). Systemic corticosteroid use fell by 42% in patients with severe exacerbations and by 28% in those with moderate ones.

This is a secondary pooled analysis and applies only to the eosinophilic phenotype. Cost is the main barrier in most settings.

• Check blood eosinophils in every patient with COPD who has frequent exacerbations
• Consider dupilumab for patients with eosinophils of 300 or more who exacerbate despite triple inhaled therapy
• Count cumulative oral steroid courses — a reduction is a real benefit to the patient
• Optimise inhaler technique, smoking cessation and rehabilitation before escalating to biologics

Why it matters

It shows the benefit reaches the outcomes patients and services feel most — admissions and steroid exposure.

Don't overread it

This is a secondary pooled analysis, and applies only to patients with raised eosinophils.

The statistics, in plain English

A rate ratio of 0.62 means 38% fewer emergency visits or admissions per patient-year; the interval (0.43 to 0.90) stays below 1 but is wide, because these events were relatively uncommon.

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