BACKGROUND Previous randomized controlled trials have established the efficacy of dupilumab among patients with chronic obstructive pulmonary disease (COPD) treated with triple therapy over 52 weeks of follow-up. OBJECTIVE This population-based cohort study aimed to explore the long-term safety and effectiveness of dupilumab in patients with COPD. METHODS The study included US patients with COPD who were seen between April 2017 and August 2024. Patients initiating dupilumab and therapies that incorporated long-acting β2-agonist (LABA) inhalers were included. Patients with asthma or lung cancer were excluded. The risk of outcomes occurring after initiation of dupilumab versus LABA-containing therapies was measured. For detailed methods, please see the Methods section in this article's Online Repository at www.jacionline.org. RESULTS A total of 1521 dupilumab initiators and 1521 propensity score-matched patients who were receiving LABA-based therapies were included. Receiving dupilumab was associated with lower all-cause mortality (hazard ratio [HR] = 0.53, 95% CI = 0.43-0.65), fewer emergency department visits (HR = 0.78, 95% CI =0.69-0.89), and lower acute exacerbation rates (HR = 0.59, 95% CI = 0.53-0.65). Dupilumab was also associated with reductions in the requirement for short-acting β2-agonists (HR = 0.48, 95% CI = 0.43-0.52) and short-acting muscarinic antagonists (HR = 0.43, 95% CI = 0.37-0.49) for symptom control. Additionally, dupilumab decreased rates of subsequent pneumonia (HR = 0.65, 95% CI = 0.50-0.86), and COPD-relevant comorbidities, including new-onset heart failure (HR = 0.69, 95% CI = 0.53-0.90) and new-onset anxiety (HR = 0.70, 95% CI =0.53-0.93). CONCLUSIONS In patients with COPD, dupilumab was associated with a lower mortality rate, fewer emergency department visits, and a reduced risk of acute exacerbations, respiratory symptoms, and respiratory infections. More studies are needed to validate the efficacy of dupilumab among patients with COPD of various severities.

中文翻译：

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dupilumab 在慢性阻塞性肺病患者中的临床疗效和安全性：一项为期 7 年的基于人群的队列研究。


背景 先前的随机对照试验已经确定了 dupilumab 在接受三联疗法治疗的慢性阻塞性肺病 （COPD） 患者中的疗效，随访 52 周。目的 这项基于人群的队列研究旨在探讨 dupilumab 在 COPD 患者中的长期安全性和有效性。方法 该研究包括 2017 年 4 月至 2024 年 8 月期间就诊的美国 COPD 患者。纳入开始使用 dupilumab 和结合长效 β2-激动剂 （LABA） 吸入器的治疗的患者。哮喘或肺癌患者被排除在外。测量了 dupilumab 开始与含 LABA 的治疗后发生结局的风险。有关详细方法，请参阅本文 Online Repository 中 www.jacionline.org 的方法部分。结果 共纳入 1521 例 dupilumab 起始剂和 1521 例倾向评分匹配的接受基于 LABA 的治疗的患者。接受度普利尤单抗治疗与较低的全因死亡率 （风险比 [HR] = 0.53,95% CI = 0.43-0.65）、较少的急诊就诊次数 （HR = 0.78,95% CI =0.69-0.89） 和较低的急性加重率 （HR = 0.59,95% CI = 0.53-0.65） 相关。度普利尤单抗还与症状控制对短效 β2 受体激动剂 （HR = 0.48， 95% CI = 0.43-0.52） 和短效毒蕈碱受体拮抗剂 （HR = 0.43， 95% CI = 0.37-0.49） 的需求减少有关。此外，度普利尤单抗降低了后续肺炎的发生率 （HR = 0.65,95% CI = 0.50-0.86） 和 COPD 相关合并症，包括新发心力衰竭 （HR = 0.69,95% CI = 0.53-0.90） 和新发焦虑 （HR = 0.70,95% CI =0.53-0.93）。 结论 在 COPD 患者中，度普利尤单抗与较低的死亡率、较少的急诊就诊次数以及降低急性加重、呼吸道症状和呼吸道感染的风险相关。需要更多的研究来验证 dupilumab 对不同严重程度的 COPD 患者的疗效。