Dupilumab Reduces Exacerbations and Improves Lung Function and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease and Type 2 Inflammation: The Notus Trial

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Introduction: Phase 3 BOREAS (NCT03930732) demonstrated efficacy and a significant reduction in exacerbation frequency in patients (pts) with chronic obstructive pulmonary disease (COPD) and type 2 inflammation. Phase 3 NOTUS (NCT04456673) aimed to confirm the efficacy and safety of dupilumab (DPL) in the same pt population as BOREAS. Methods: NOTUS was a 52-week (w), randomized, double-blind, placebo (PBO)-controlled trial assessing efficacy and safety of subcutaneous add-on DPL 300 mg q2w or PBO. Enrolled pts (40 to 85 years) with COPD had moderate-to-severe airflow limitation, type 2 inflammation (blood eosinophils [eos]≥300 cells/μL at screening) and were on triple therapy with inhaled corticosteroids (ICS), long-acting β 2 -agonists (LABA), and long-acting muscarinic antagonists (LAMA) (or LABA/LAMA if ICS were contraindicated). Primary analysis was performed on interim data. Results : Pts (N=935) were randomized to DPL/PBO (n=470/465). DPL vs PBO reduced the annualized moderate-to-severe exacerbation rates (primary endpoint) by 34% (relative risk [95% CI] 0.664 [0.535, 0.823]; P =0.0002). At W12, DPL increased pre-bronchodilator FEV 1 (LS mean difference: 82 mL; P =0.0001) vs PBO, maintained at W52 (LS mean difference: 62 mL; P =0.0182). DPL improved St. George's Respiratory Questionnaire score at W52 (LS mean difference:−3.37; nominal P =0.0068) vs PBO. The median change in blood eos (cells/μL) from baseline (BL) to W52 was –45 for DPL vs –40 for PBO. For the BL (Week 0) blood eos subgroup analysis, reduction in annualized moderate-to-severe exacerbation rates was similar in those with BL blood eos<300 (n=372) or≥300 (n=562) cells/μL (relative risk vs PBO: 0.620 and 0.685, respectively). Safety findings were similar to BOREAS. Conclusions : In pts with COPD and type 2 inflammation, DPL reduced rates of moderate or severe exacerbations in both patients with blood eos counts<300 and≥300 cells/μL, and improved lung function and health-related quality of life. The safety profile of DPL was generally consistent with other DPL indications. Publication History Article published online: 18 March 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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