Real-World Dupilumab in Type 2 Chronic Obstructive Pulmonary Disease (COPD): A Single-Centre Compassionate-Use Case...

Area of Science:

• Pulmonology
• Immunology
• Clinical Trials

Background:

• Dupilumab, a monoclonal antibody targeting IL-4Rα, shows promise for type 2 (T2)-inflamed chronic obstructive pulmonary disease (COPD).
• Limited real-world data exists for dupilumab in elderly COPD patients with a chronic bronchitis phenotype.

Purpose of the Study:

• To evaluate the real-world effectiveness of dupilumab in older adults with T2-inflamed COPD and chronic bronchitis.
• To assess changes in exacerbation rates, lung function, and symptom burden in this patient population.

Main Methods:

• A single-centre case series of 12 elderly patients with T2-inflamed COPD receiving dupilumab (300 mg every two weeks) via compassionate use.
• Patients had ≥2 moderate or ≥1 severe exacerbation despite triple inhaled therapy and blood eosinophils ≥300 cells/µL.
• Endpoints included annualised exacerbation rate (AER), CAT scores, and FEV1, with follow-up up to 12 months (primary analysis at 6 months).

Main Results:

• Severe exacerbations significantly decreased (mean AER 0.75 to 0.19 events/patient-year; p=0.0156).
• Mean FEV1 increased by 120 mL at 6 months (p=0.007), and total CAT scores improved significantly (p=0.0007).
• Mucus-related symptoms (CAT item 2) showed marked improvement (p<0.001).

Conclusions:

• Dupilumab demonstrated significant reductions in severe exacerbations and improvements in lung function and mucus symptoms in elderly T2-inflamed COPD patients.
• The findings support dupilumab's utility in a real-world setting for this specific COPD phenotype.
• Further research is needed to confirm these results and investigate potential mortality benefits.