An Eczema and Asthma Drug Cut Flare-Ups in an Inflammatory Form of COPD

CATEGORY: IMMUNE HEALTH

For decades, COPD treatment has meant inhalers, and for many patients the flare-ups kept coming anyway. The 52-week NOTUS trial tested something new: dupilumab, an injectable drug first approved for eczema and asthma, cut COPD flare-ups by 34% in patients whose blood showed a particular inflammatory signature, 0.86 versus 1.30 exacerbations per year.¹

Reading Inflammation Off a Routine Blood Count

Chronic obstructive pulmonary disease, or COPD, slowly narrows the airways, and its flare-ups land people in the hospital and permanently cost them lung capacity. In some patients, the disease runs on so-called type 2 inflammation, the same immune pathway behind eczema and much of asthma. The marker is ordinary. It’s a high eosinophil count, one line on the standard blood panel most adults have had. Everyone in this trial had moderate or severe COPD that kept flaring despite triple inhaler therapy, plus an eosinophil count of at least 300. Dupilumab blocks two chemical messengers, interleukin-4 and interleukin-13, that drive that pathway.

A Year of Counting Flare-Ups

The trial enrolled 935 patients. Neither they nor their physicians chose the treatment; randomization split them between a dupilumab injection every two weeks and placebo, on top of their inhalers. Over the year, the dupilumab group averaged a third fewer moderate or severe flare-ups.¹ Their breathing improved too. A standard measure of how much air leaves the lungs in one second rose 82 milliliters more than with placebo by week 12. One expected win didn’t materialize: on a detailed quality-of-life questionnaire, the groups weren’t meaningfully apart at the year’s end. Side effects were about as common with the drug as without it.

The Second Trial Saying the Same Thing

NOTUS was run deliberately as a confirmation. An earlier trial of the same design, BOREAS, had found 30% fewer exacerbations in 939 similar patients.² The answers matched. Two large trials landing within a few points of each other is what moved regulators: dupilumab became the first biologic medicine approved in the United States for COPD. For patients whose disease keeps breaking through maximal inhaler treatment, the eosinophil line on a routine blood test now identifies who stands to benefit from an entirely new option.

Key Takeaways

• In COPD patients with high eosinophil counts still flaring on triple inhaler therapy, dupilumab cut exacerbations by about a third over a year, a result an earlier twin trial had already found.
• Lung function improved modestly, but overall quality-of-life scores didn’t separate from placebo by week 52.
• The benefit applies to a specific group: this trial says nothing about COPD without the type 2 inflammation marker.

References

1. Bhatt SP, et al, for the NOTUS Study Investigators. Dupilumab for COPD with Blood Eosinophil Evidence of Type 2 Inflammation. N Engl J Med. 2024;390(24):2274–2283. link
2. Bhatt SP, et al, for the BOREAS Investigators. Dupilumab for COPD with Type 2 Inflammation Indicated by Eosinophil Counts. N Engl J Med. 2023;389(3):205–214. link