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Chronic obstructive pulmonary disease (COPD) is an inflammatory disorder classically attributed to macrophages, neutrophils, and CD8 lymphocytes. However, as many as 40% of patients have type 2 inflammation, characterized by sputum, tissue, or peripheral eosinophilia. Dupilumab, an anti–interleukin 4/13 monoclonal antibody, effectively treats patients with type 2 asthma but has not been studied yet in managing COPD.
In an industry-sponsored, international trial, 939 patients with COPD and blood eosinophil counts of ≥300/µL were randomized to dupilumab or placebo injections every 2 weeks. Patients had excess risk for exacerbations despite using inhaled triple therapy (i.e., long-acting muscarinic antagonist, β-agonist, and corticosteroid). Du…