BOREAS: Blood eosinophil count and FeNO levels predictive of dupilumab response in COPD

Baseline blood eosinophil counts and FeNO levels were predictive of treatment response to dupilumab in patients with chronic obstructive pulmonary disease (COPD) and type 2 inflammation, a post-hoc analysis of the phase 3 BOREAS trial showed. Although dupilumab outperformed placebo across all biomarker levels, larger treatment effects were observed for patients with higher baseline levels of the 2 aforementioned biomarkers.

The phase 3 BOREAS trial demonstrated the superiority of dupilumab over placebo in terms of reducing exacerbations and improving lung function, quality-of-life, and symptoms in patients with COPD and type 2 inflammation [1]. The 939 participants enrolled in BOREAS were randomised 1:1 to dupilumab or placebo. The current post-hoc analysis investigated treatment- by-biomarker interaction effects on the annualised rate of moderate or severe acute exacerbations of COPD [2].

“The dupilumab treatment effect increased with higher baseline blood eosinophil counts,” said Dr Stephanie Christenson (University of California San Francisco, CA, USA):

• 300 cells/ μL category: 25% improvement versus placebo
• 500 cells/ μL category: 29% improvement versus placebo
• 700 cells/ μL category: 39% improvement versus placebo
• 900 cells/ μL category: 52% improvement versus placebo; P-value for interaction=0.006

Likewise, higher baseline FeNO levels were associated with a larger treatment effect. In the ≥20 ppb category, exacerbations were reduced by 29% in participants receiving dupilumab versus those receiving placebo. In the ≥40 ppb category, the corresponding reduction in exacerbations was 42% (P-value for interaction=0.043). “Compared with placebo, dupilumab reduced moderate-to-severe exacerbations across all measured biomarker levels,” concluded Dr Christenson. “The treatment effect was significantly larger in patients with higher baseline blood eosinophil counts and in those with higher baseline FeNO levels.”

1. Bhatt S, et al. N Engl J Med 2023;389:205-214.
2. Nicola A, et al. Baseline blood eosinophils and FeNO predict dupilumab response in COPD with type 2 inflammation: phase 3 BOREAS trial. C95: New clinical trial results in chronic lung disease. ATS 2024, 17–22 May, San Diego, USA.

Medical writing support was provided by Robert van den Heuvel.

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Posted on 10 June 202412 June 2024