Dupilumab Lessens COPD Exacerbation Impact, with Nicola Hanania, MD, MS

Dupilumab (Dupixent) reduced not only the rate of exacerbations, but their impact on lung function in treated patients with chronic obstructive pulmonary disease (COPD), according to late-breaking data presented at the American College of Chest Physicians (CHEST) 2025 Annual Meeting in Chicago, IL, this week.¹

Post hoc pooled data from the phase 3, randomized, placebo-controlled BOREAS and NOTUS trials showed subcutaneous 300 mg add-on dupilumab with triple inhaler therapy resulted in an approximate 6.1 percentage-point reduction in moderate-to-severe COPD exacerbation risk versus placebo. The biologic therapy regimen also was linked to a numerically less impaired change in mean post-bronchodilator percent predicted forced expiratory volume in 1 second (ppFEV₁) following exacerbations.

The US Food and Drug Administration (FDA) approved dupilumab for the treatment of patients with COPD based on the findings from BOREAS and NOTUS in September 2024.²

The new findings, presented by Nicola A. Hanania, MD, MS, professor of medicine and director of the Asthma Clinical Research Center at Baylor College of Medicine, suggest that dupilumab may protect lung function in patients with COPD who experience ≥1 moderate or severe exacerbation during their treatment with the biologic therapy.¹ If investigators can find further evidence that patient lung function is preserved or improved through dupilumab, COPD exacerbations may not indicate treatment failure.

In an interview with HCPLive at CHEST 2025, Hanania emphasized the impact of these new findings. Approximately one-fourth of all patients with COPD who experience an exacerbation never fully recover lung function back to baseline health. Dupilumab may help prevent the permanent dip in lung function — before, during, and even after an exacerbation.

“In addition to the fact that dupilumab can reduce exacerbation in this population, it may actually have a protective effect…on lung function during the attack,” Hanania said.

An interleukin-4 and -13 (IL-4; IL-13) pathway inhibitor, dupilumab targets the cytokines that propagate inflammation. This observed clinical effect on exacerbation impact helps elucidate the physiology of COPD — a condition without any prospects for curation. As Hanania explained, the biologic drug class including dupilumab has only recently provided clinicians more ability to personalize their targeted treatment approach for patients.

“About 50% of patients on standard-of-care therapy continue to exacerbate, so there is still a big, unmet need,” Hanania said. If the biologic drug class can mitigate the frequency and harms of exacerbations, then future treatment regimens may afford patients with COPD a state of disease stability.

“Maybe in the future we will [get closer to a cure], but we at least want to get them to a level where the lung function will not decline as quickly as it would without these drugs — that they would not get exacerbations, because with every exacerbation, there's a big hit,” Hanania said.

Hanania's disclosures include Sanofi, Genzyme, Regeneron, GSK, AstraZeneca, Regeneron, Genentech, and Merck.

References

1. ^{Hanania NA, Brightling C, Puggioni F, Bhatt SP, et al. COPD Exacerbations Have Less Impact on Lung Function During Dupilumab Treatment: Pooled Analysis from BOREAS and NOTUS. Poster presented at: CHEST Annual Meeting 2025. Chicago, IL. October 19 – 22, 2025.}
2. ^{Smith T. FDA Approves Dupilumab (Dupixent) for Treatment of COPD. HCPLive. Published September 27, 2024. https://www.hcplive.com/view/fda-approves-dupilumab-dupixent-for-treatment-of-copd}