BOREAS Trial: New Findings on Type 2 Inflammation in COPD

Pooled data showed that adding dupilumab to standard triple therapy can significantly reduce exacerbations, improve lung function, and patient-reported outcomes, says Klaus Rabe, MD, PhD, chest physician and professor of medicine, University of Kiel.

This transcript was lightly edited.

Transcript

How do the findings from the BOREAS trial expand our understanding of the role of type 2 inflammation in COPD, particularly for nonexacerbators?

BOREAS opened up a completely new understanding of presentations in terms of inflammation of COPD. Turns out that there are individuals who have the classical history lifespan exposure to cigarette smoke compared with others, but they have a form of inflammation measured by eosinophils and blood, for example, partly with inhaled XO/exhaled XO [nitric oxide] levels that are increased. That's what we classically call type 2 inflammation. It seems to be prevalent in a group of individuals that we know of from genetic studies of the COPD gene that they have, particularly.

There the numbers were 20% to 40% of these people with COPD might have the type 2 inflammation. I think they might vary geographically around the world. But we don't know that. But I think it's fair to say that by intervention with a drug that addresses type 2 inflammation, dupilumab in this case, you could positively identify a subgroup of people with COPD where type 2 inflammation plays a role. Since it does play a role, it's amenable to change with something that addresses type 2 inflammation through, for example, a monoclonal antibody, something like Dupixent.

What are the potential implications of using dupilumab in terms of long-term management and quality of life?

The options of the new data would suggest that someone who has that type of inflammation, even though he is on effective treatment—because most people, if not all of them, were under triple therapy [of a] long-acting bronchodilator β-agonist, long-acting bronchodilator anticholinergic drug, plus a steroid. So these individuals were adequately treated based on their characteristics and the disease, but still when they were still exacerbating or when they were unstable, they would benefit from adding an IL-4 [interleukin-4]/IL-13 [interleukin-13] antibody, in this case, dupilumab, to actually make them more stable, resulting in a significant reduction of exacerbations, improving their lung function, even though they did have bronchodilators in their therapeutic algorithm, and improving what we call PROs, patient-related outcomes—symptoms that are very important for a lot of people.