Clinical Effectiveness and Safety of Dupilumab in Chronic Obstructive Pulmonary Disease Patients: A 7-Year Population-based Cohort Study

Chuan-Yen Sun; Yohannes Tesfaigzi; Gin-Yi Lee; Yi-Hsuan Chen; Scott T Weiss; Kevin Sheng-Kai Ma

doi:10.1016/j.jaci.2024.09.019

Clinical Effectiveness and Safety of Dupilumab in Chronic Obstructive Pulmonary Disease Patients: A 7-Year Population-based Cohort Study

J Allergy Clin Immunol. 2024 Oct 3:S0091-6749(24)01021-2. doi: 10.1016/j.jaci.2024.09.019. Online ahead of print.

Authors

Chuan-Yen Sun¹, Yohannes Tesfaigzi², Gin-Yi Lee³, Yi-Hsuan Chen⁴, Scott T Weiss⁵, Kevin Sheng-Kai Ma⁶

Affiliations

¹ Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
² Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
³ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA.
⁵ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
⁶ Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: kema@mgh.harvard.edu.

PMID: 39368553
DOI: 10.1016/j.jaci.2024.09.019

Abstract

Background: Previous randomized controlled trials had established the efficacy of dupilumab among patients with chronic obstructive pulmonary disease (COPD) treated with triple therapy over 52 weeks of follow-up.

Objective: This population-based cohort study aimed to explore the long-term clinical effectiveness of dupilumab in COPD patients.

Methods: This population-based cohort study included U.S. patients with COPD between April 2017 and August 2024. Patients initiating dupilumab and therapies that incorporated long-acting β2-agonists (LABA) inhalers were included. Patients with asthma or lung cancer were excluded. The risk of outcomes after the initiation of dupilumab versus LABA-containing therapies was measured. For detailed Methods, please see the Methods section in this article's Online Repository at www.jacionline.org.

Results: A total of 1,521 dupilumab initiators and 1,521 propensity score-matched patients receiving LABA-based therapies were included. Dupilumab recipients were associated with lower all-cause mortality (HR:0.53, 95% CI:0.43-0.65), emergency visits (HR:0.78, 95% CI:0.69-0.89), and acute exacerbation (AE) rates (HR:0.59, 95% CI:0.53-0.65). Dupilumab was also associated with reductions in the requirement of short-acting β2-agonists (HR:0.48, 95% CI:0.43-0.52), short-acting muscarinic antagonists (HR:0.43, 95% CI:0.37-0.49) for symptoms control. Additionally, dupilumab decreased subsequent pneumonia (HR:0.65, 95% CI:0.50-0.86), and COPD-relevant comorbidities including new-onset heart failure (HR:0.69, 95% CI:0.53-0.90) and new-onset anxiety (HR:0.70, 95% CI:0.53-0.93).

Conclusions: Dupilumab was associated with a lower rate of mortality, emergency visits, reduced risk of AEs, respiratory symptoms, and respiratory infections in COPD patients. More studies are required to validate the effectiveness of dupilumab among patients with COPD across various severities.

Keywords: COPD; acute exacerbations; anti-IL13 receptor; anti-IL4 receptor.