Journal club

Abstract

Chronic obstructive pulmonary disease (COPD) is characterised by reduced lung function and frequent exacerbations, which can worsen symptoms, increasing the risk of further health decline and mortality. Although COPD has long been recognised as involving an amplified innate immune response, recent findings suggest that type two inflammation, present in 20–40% of COPD patients, could be a therapeutic target. The BOREAS trial ( N Engl J Med 2023;389:205–14) investigated the efficacy and safety of dupilumab, a monoclonal antibody that inhibits interleukin-4 and interleukin-13, in reducing exacerbations and improving lung function in COPD patients with type two inflammation. The phase 3, multicenter, double-blind, placebo-controlled trial enrolled 939 COPD patients with blood eosinophil count of at least 300 per microliter, and a high exacerbation risk despite standard triple therapy. Participants were randomised to receive either 300 mg of dupilumab or placebo biweekly for 52 weeks, alongside their standard inhaled therapies. The primary endpoint was the annualised rate of moderate or severe COPD exacerbations. Dupilumab significantly reduced the annualised rate of moderate or severe exacerbations compared with placebo (0.78 vs 1.10; rate ratio, 0.70; 95% CI, 0.58 to 0.86; p<0.001). Additionally, patients treated with dupilumab showed greater improvements in …