Dupilumab Enhances Quality of Life and Relieves Respiratory Symptoms in COPD Patients with Type 2 Inflammation: Insights from BOREAS and NOTUS Trials

Key Findings

A total of 1,660 patients completed the 52-week treatment phase across both groups (830 patients in each arm). Analysis revealed statistically significant and clinically meaningful improvements with dupilumab compared to placebo in both HRQoL and respiratory symptom severity measures.

– SGRQ Total Score: Dupilumab lowered the mean total score by a least squares mean difference of -3.4 (95% CI: -5.0 to -1.8; P < .0001) relative to placebo, denoting improved quality of life.

– E-RS:COPD Total Score: Dupilumab achieved a reduction of -0.9 (95% CI: -1.4 to -0.4; P = .0006) compared to placebo, indicating less respiratory symptom burden.

Domain-specific improvements included:

– SGRQ Symptoms: –3.5 (95% CI: -5.5 to -1.5)
– SGRQ Activity: –4.0 (95% CI: -5.9 to -2.1)
– SGRQ Impacts: –2.9 (95% CI: -4.6 to -1.1)
– E-RS Breathlessness: –0.6 (95% CI: -0.8 to -0.3)
– E-RS Cough and Sputum: –0.2 (95% CI: -0.3 to 0.0)
– E-RS Chest Symptoms: –0.1 (95% CI: -0.3 to 0.0)

These effects signify improvements not only in physical activity and symptom burden but also in psychosocial and chest-related symptoms. Importantly, the magnitude of change in SGRQ total score surpasses the commonly accepted minimal clinically important difference (MCID) of 4 units, underscoring the clinical relevance of dupilumab’s impact.

Safety profiles across both treatment arms were comparable, with no unexpected adverse events reported, confirming dupilumab’s tolerability in this patient population.

Expert Commentary

The pooled analysis from BOREAS and NOTUS represents a pivotal step in COPD management by targeting a specific inflammatory phenotype with biologic therapy. Current COPD treatments mainly focus on bronchodilation and corticosteroids; however, residual symptom burden often persists, particularly in patients exhibiting type 2 inflammation.

Dupilumab’s mechanism inhibiting IL-4 and IL-13 signaling pathways offers biologic plausibility for attenuating inflammation-driven symptoms and improving quality of life. The robust improvement in patient-centered outcomes highlights the importance of incorporating PROs to guide personalized therapy.

Limitations include the study population selected for type 2 biomarker positivity, which might limit broader generalizability. Moreover, while symptom relief is evident, long-term effects on exacerbation rates and lung function decline require further evaluation. The integration of dupilumab into COPD treatment paradigms should be considered in the context of clinical guidelines and cost-effectiveness analyses.

Conclusion

The addition of dupilumab to standard triple therapy in COPD patients with type 2 inflammation yields significant benefits in health-related quality of life and respiratory symptoms, as demonstrated by consistent improvements in SGRQ and E-RS:COPD scores over 52 weeks. These findings support dupilumab as a promising targeted intervention that addresses an unmet need for personalized management of COPD, reinforcing the utility of phenotype-directed treatment strategies.

Further research is warranted to clarify its long-term impact on disease progression, exacerbation prevention, and integration into routine clinical practice.

References

Bhatt SP, Rabe KF, Hanania NA, Vogelmeier CF, Bafadhel M, Christenson SA, Papi A, Singh D, Laws E, Dakin P, Maloney J, Lu X, Bauer D, Bansal A, Abdulai RM, Robinson LB. Effect of Dupilumab on Health-Related Quality of Life and Respiratory Symptoms in Patients With COPD and Type 2 Inflammation: BOREAS and NOTUS. Chest. 2025 Jul;168(1):56-66. doi: 10.1016/j.chest.2025.01.029. Epub 2025 Jan 31. PMID: 39894389.