Dupilumab quickly alleviates patient-reported symptoms in people with COPD and type 2 inflammation, new pooled data from the BOREAS and NOTUS randomized controlled trials suggest.
Dupilumab was associated with improved COPD symptoms at day 4 and continued through day 14, with symptom reduction showing a weak correlation with early lung function improvements.
COPD symptoms, including dyspnea, cough, and sputum production, can greatly bother patients with COPD. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin-4/-13, which are key drivers of type 2 inflammation.
The phase 3 BOREAS and NOTUS trials enrolled patients with COPD receiving triple therapy who had moderate-to-severe airflow limitation and type 2 inflammation (documented by screening blood eosinophil counts>300 cells/μL). Every two weeks for 52 weeks, 938 participants received add-on dupilumab 300 mg and 936 received placebo.
Every day, participants completed the 11-item Evaluating Respiratory Symptoms in COPD (E-RS:COPD) diary that recorded dynamic symptom changes as well as the effects of those changes on the participants. Pre- and post-bronchodilator forced expiratory volume in 1 second (FEV₁) were measured on day 14, and the researchers calculated Spearman correlation coefficients (rs) between baseline and Day 14 changes.
The researchers analyzed early symptom changes that accompanied early lung function changes during the first 2 weeks of treatment in patients enrolled in both trials.
The mean baseline E-RS:COPD score for both treatment and placebo groups was 12.7. At day 2, the mean change from baseline was numerically greater with dupilumab compared with placebo, with changes in E-RS:COPD score of -0.2 vs -0.1, respectively.
At day 4, a statistically significant difference emerged in E-RS:COPD score changes, with -0.3 versus -0.1 (P=0.0211). At day 14, the difference between the groups remained, with an E-RS:COPD score change of -0.8 for dupilumab and -0.1 for placebo (P=0.0004).
Within the first 14 days of treatment, the researchers also detected weak correlations between E-RS:COPD score changes, pre-bronchodilator FEV₁ (dupilumab: rs = 0.14; placebo: rs = 0.15) and post-bronchodilator FEV₁ (dupilumab: rs = 0.14; placebo: rs = 0.15).
Reference
Wedzicha J, Bhatt SP, Singh D, et al. Win Ratio Analysis of Dupilumab Efficacy in BOREAS and NOTUS: Clearer Wins for Patients With Chronic Obstructive Pulmonary Disease and Type 2 Inflammation. Presented at: CHEST 2025, October 19-22, 2025; Chicago.
