A POST HOC analysis of the Phase 3 BOREAS trial shows that dupilumab significantly reduces Type 2 inflammatory biomarkers and exacerbation risk in patients with chronic obstructive pulmonary disease (COPD) and raised eosinophil levels.
The BOREAS trial, conducted across 275 sites in 24 countries, enrolled 939 patients with COPD and blood eosinophil counts ≥300 cells/μL, a recognised marker of Type 2 inflammation. Participants were randomly assigned to receive either 300 mg of dupilumab or placebo every 2 weeks for 52 weeks. This secondary analysis assessed the predictive value and trajectory of several Type 2 inflammation biomarkers, including eosinophil counts, fractional exhaled nitric oxide (FeNO), serum eotaxin-3, total immunoglobulin E (IgE), and pulmonary and activation-regulated chemokine (PARC), aiming to better understand dupilumab’s mechanism and its potential in biomarker-guided COPD therapy.
At Week 52, dupilumab demonstrated greater median percentage reductions in key biomarkers compared with placebo. These included total IgE (−22.5% vs −0.9%), FeNO (−28.6% vs −6.9%), eotaxin-3 (−8.8% vs −0.4%), and PARC (−14.4% vs −0.8%). Notably, reductions were consistent regardless of baseline eosinophil counts, yet the reduction in exacerbation risk was more pronounced in patients with higher baseline eosinophils (p=0.0056) and FeNO levels (p=0.043). The cohort was predominantly male (66%) and composed mainly of former smokers (70%), with the remainder being current smokers (30%).
These findings indicate that dupilumab not only modulates inflammatory biomarkers but also offers greater clinical benefit to patients with COPD who have higher markers of Type 2 inflammation. This evidence strengthens the case for biomarker-guided management in chronic airway disease.
Reference
Christenson SA et al. Type 2 inflammation biomarkers and their association with response to dupilumab in COPD (BOREAS): an analysis of a randomised, placebo-controlled, phase 3 trial. Lancet Respir Med. 2025; DOI: 10.1016/S2213-2600(25)00044-X.
