Efficacy of dupilumab and mepolizumab in eosinophilic COPD: insights from phase 3 trials
Philipp Suter, Robert Greig, Rory Chan, Brian J. Lipworth
Abstract
BACKGROUND: Eosinophilic chronic obstructive pulmonary disease (eCOPD), characterized by type 2 inflammation, is an emerging target for biologic therapies. OBJECTIVE: To indirectly compare the efficacy of dupilumab and mepolizumab in eCOPD, defined as blood eosinophil counts ≥300 cells/μL, by synthesizing data from phase 3 randomized controlled trials: BOREAS and NOTUS for dupilumab, MATINEE for mepolizumab. METHODS: ). Rate ratios and mean differences with crude 95 % CI were evaluated using forest plots. RESULTS: , along with enhanced effects in patients with elevated fractional exhaled nitric oxide (FeNO ≥20 ppb). None of the secondary outcomes reached the minimal clinical important difference. CONCLUSION: While both biologics reduced AER in eCOPD, dupilumab demonstrated statistically but not clinically relevant improvements on quality of life, symptoms, and lung function. Especially in patients with elevated FeNO, dupilumab demonstrated an improvement. Further direct comparisons and biomarker-driven studies are warranted.