Dupilumab raised FEV1 by about 80 mL in COPD with type 2 inflammation

Design

Post hoc pooled analysis of two phase 3 randomised placebo-controlled trials

Population

1,874 patients with COPD and type 2 inflammation

Primary outcome

Change in spirometric lung function

Effect

Pre-bronchodilator FEV1 +83 mL (95% CI 53–112); post-bronchodilator +71 mL (41–101)

A post hoc analysis pooled the BOREAS and NOTUS trials, in which 1,874 patients with COPD and type 2 inflammation (raised blood eosinophils) were randomised to dupilumab 300 mg every two weeks or placebo for 52 weeks on top of inhaled therapy.

Dupilumab improved pre-bronchodilator FEV1 by 83 mL (95% CI 53–112) and post-bronchodilator FEV1 by 71 mL, with smaller gains in FVC and mid-expiratory flow, seen by week 12 and sustained to week 52. Improvements held regardless of smoking status or emphysema and were larger with higher eosinophil counts or exhaled nitric oxide. More than 100 mL improvement in FEV1 was seen in 42% versus 31% at week 12.

The parent trials showed fewer exacerbations; this analysis adds that lung function improves too. Biologic therapy for COPD is costly and access in India is limited, so selection by eosinophil count matters.

• Check blood eosinophils in COPD patients who keep exacerbating despite triple inhaled therapy
• Dupilumab improved FEV1 by about 70–80 mL in type 2 COPD
• Benefit was greater with higher eosinophils or exhaled nitric oxide
• Gains held in current smokers and in those with emphysema

Why it matters

It confirms a subgroup of COPD responds to targeting type 2 inflammation, not just bronchodilation.

Don't overread it

This is a post hoc analysis of secondary lung-function outcomes; the trials were powered for exacerbations.

The statistics, in plain English

A difference of 83 mL in FEV1 is modest — a clinically noticeable change is often taken as about 100 mL — but it was consistent and sustained over a year.

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