{
  "abstract": "Purpose In BOREAS and NOTUS, add-on dupilumab reduced moderate-or-severe exacerbation rates and improved lung function in patients with chronic obstructive pulmonary disease (COPD) and type 2 inflammation. This post hoc analysis explored the predictive value of baseline blood eosinophil counts and fractional exhaled nitric oxide (FeNO) for response to dupilumab treatment in patients with COPD and type 2 inflammation.Methods BOREAS ( NCT03930732) and NOTUS (NCT04456673), Phase 3, randomized, placebo-controlled trials, enrolled 1874 patients (aged 40–85) COPD with moderate-to-severe airflow obstruction, and type 2 inflammation (screening blood eosinophil count ≥300 cells/mL) on triple inhalation therapy. Patients received dupilumab 300 mg every two weeks (q2w) or placebo for 52 weeks. Treatment rate ratios of dupilumab vs placebo and adjusted annualized moderate-or-severe exacerbation rates over a range of type 2 biomarkers were evaluated.Results The treatment rate ratio for moderate-or-severe exacerbations was 0.70 (95% confidence interval [CI]:0.61–0.81), 0.71 (0.61–0.83), 0.71 (0.61–0.83), and 0.72 (0.61–0.83) for patients with baseline blood eosinophil counts of 300, 500, 700, or 900 cells/µL, respectively (continuous biomarker-by-treatment interaction P=0.09). Reductions in exacerbation rates were observed over a range of baseline blood eosinophil counts (dupilumab: 0.57 [95% CI:0.51–0.63] for 300 cells/mL to 0.58 [0.51–0.65] for 900 cells/mL]; placebo: 0.81 [0.73–0.89] for 300 cells/mL to 0.81 [0.73–0.89] for 900 cells/mL). Furthermore, the treatment rate ratio for moderate-or-severe exacerbations was 0.69 (95% CI:0.59–0.80) and 0.67 (0.53–0.85) for patients with baseline immunoglobulin E (IgE) levels 100 IU/mL and 1000 IU/mL, respectively (continuous biomarker-by-treatment interaction P=0.83); reductions in exacerbation rates were observed regardless of baseline IgE levels (dupilumab: 0.56 [95% CI:0.50–0.63] for 100 IU/mL to 0.53 [0.44–0.63] for 1000 IU/mL; placebo: 0.82 [0.74–0.90] for 100 IU/mL to 0.78 [0.67–0.92] for 1000 IU/mL). Reductions in treatment rate ratio for exacerbations were also observed with increasing baseline FeNO levels from 0.69 (95% CI:0.60–0.80) for 20 parts per billion (ppb) to 0.56 (0.46–0.69) for 40 ppb (continuous biomarker-by-treatment interaction P=0.006), indicating a significant predictive value.Conclusion Dupilumab vs placebo reduced exacerbations independently of baseline blood eosinophil counts and IgE. Higher baseline FeNO levels were associated with a greater exacerbation reduction with dupilumab treatment compared with placebo.",
  "authors": [
    {
      "affiliations": [
        "University of Sherbrooke, Sherbrooke, QC, Canada"
      ],
      "name": "S Couillard"
    },
    {
      "affiliations": [
        "Institute for Respiratory Health, University of Western Australia, Perth, WA, Australia"
      ],
      "name": "S Ramakrishnan"
    },
    {
      "affiliations": [
        "Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK"
      ],
      "name": "I Pavord"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Copenhagen University Hospital – Herlev and Gentofte, Copenhagen, Denmark",
        "Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"
      ],
      "name": "Y Çolak"
    },
    {
      "affiliations": [
        "Mainz University Hospital, Mainz, Germany"
      ],
      "name": "R Buhl"
    },
    {
      "affiliations": [
        "INSERM U1250, University Hospital of Reims, Reims, France"
      ],
      "name": "G Deslée"
    },
    {
      "affiliations": [
        "Sanofi, Morristown, NJ, USA"
      ],
      "name": "D Bauer"
    },
    {
      "affiliations": [
        "Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA"
      ],
      "name": "M Soliman"
    }
  ],
  "title": "S174 Reduction of exacerbations according to type 2 inflammatory biomarkers with dupilumab treatment in patients with chronic obstructive pulmonary disease",
  "uid": "52ef0941-96a6-5067-bcbf-fb25afc50c7a"
}