{"doi":"10.3390/jcm15020775","title":"Short-Term Effects of Dupilumab in Eosinophilic COPD","abstract":"<jats:p>Background/Objectives: Patients with eosinophilic chronic obstructive pulmonary disease (COPD) often remain symptomatic despite optimized triple inhaled therapy. Dupilumab is a fully human monoclonal antibody that blocks the IL-4 receptor alpha subunit, thereby inhibiting IL-4 and IL-13 signaling. Evidence from randomized trials supports dupilumab for add-on treatment of type 2-high COPD, but data referring to short-term effectiveness in clinical practice are quite limited. Methods: We conducted an observational, compassionate-use study enrolling 13 consecutive outpatients with eosinophilic COPD (blood eosinophils ≥ 300 cells/µL) receiving add-on biologic therapy with dupilumab 300 mg every two weeks. Clinical (CAT, mMRC), functional (spirometry and body plethysmography), and inflammatory parameters (blood eosinophils/basophils, fibrinogen, FeNO) were evaluated at baseline and after four weeks of treatment. Safety was monitored after injection in a clinical setting, as well as via weekly phone follow-up. Results: Participants (84.6% male; mean age 67.08 ± 11.42 years) experienced rapid and clinically meaningful improvements at four weeks. CAT score decreased from baseline 21.40 ± 6.22 to 14.00 ± 5.58 (p &lt; 0.001) and mMRC scale from 2.90 ± 0.73 to 1.80 ± 0.63 (p &lt; 0.0001), respectively. Pre-bronchodilator FEV1 increased from baseline 1.35 ± 0.65 L to 1.59 ± 0.84 L (p &lt; 0.05), and FVC from 2.36 ± 0.92 L to 2.83 ± 1.11 L (p &lt; 0.01). A marked lung deflation was observed: indeed, residual volume declined from baseline 4.17 ± 1.98 L to 3.47 ± 2.07 L (p &lt; 0.05), with a concomitant reduction in specific effective airway resistance (from baseline 3.15 ± 1.77 to 2.43 ± 1.44 kPa·s; p &lt; 0.05) associated with significant increases in mid-expiratory flow (FEF25−75: from baseline 0.62 ± 0.38 to 0.86 ± 0.71 L/s; p &lt; 0.05) and peak expiratory flow (3.80 ± 1.40 to 4.48 ± 1.79 L/s; p &lt; 0.01). Type 2 inflammatory biomarkers changed as follows: blood eosinophil count fell from baseline 390.0 ± 43.75 to 190.0 ± 65.47 cells/µL (p &lt; 0.001); blood basophil number decreased from baseline 37.50 ± 13.89 to 26.25 ± 13.02 cells/µL (p &lt; 0.001); plasma fibrinogen lowered from baseline 388.4 ± 54.81 to 334.9 ± 72.36 mg/dL (p &lt; 0.01); FeNO levels dropped from baseline 23.95 ± 18.10 to 14.00 ± 2.04 ppb (p &lt; 0.0001). Dupilumab was well tolerated, and no treatment-related serious adverse events or discontinuations were detected. Conclusions: Within an exploratory context of daily medical activity referring to eosinophilic COPD already treated with maximal inhaled therapy, we found relevant therapeutic effects of a four-week add-on treatment with dupilumab. In particular, our patients manifested rapid improvements in symptoms, airflow limitation, and lung hyperinflation, paralleled by significant decrements of type 2 inflammatory signatures. Such encouraging results were associated with a favorable short-term safety profile. However, larger and longer studies are necessary to corroborate these preliminary findings.</jats:p>","journal":"Journal of Clinical Medicine","year":2026,"id":654053,"datarank":0.20794415416798362,"base_score":1.3862943611198906,"endowment":1.3862943611198906,"self_citation_contribution":0.20794415416798362,"citation_network_contribution":0.0,"self_endowment_contribution":0.20794415416798362,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":3,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1706848,"name":"Daniela Pastore","orcid":null,"position":1,"is_corresponding":false},{"id":1706849,"name":"Giuseppina Marrazzo","orcid":null,"position":2,"is_corresponding":false},{"id":1706850,"name":"Giada Procopio","orcid":null,"position":3,"is_corresponding":false},{"id":1706851,"name":"Antonio Giacalone","orcid":null,"position":4,"is_corresponding":false},{"id":1706852,"name":"Federica Marrelli","orcid":"0009-0006-7653-9565","position":5,"is_corresponding":false},{"id":1706853,"name":"Mariarosanna De Fina","orcid":null,"position":6,"is_corresponding":false},{"id":1706854,"name":"Adele Emanuela De Francesco","orcid":null,"position":7,"is_corresponding":false},{"id":1621559,"name":"Alessandro Vatrella","orcid":"0000-0001-8265-3037","position":8,"is_corresponding":false},{"id":1706855,"name":"Santi Nolasco","orcid":"0000-0003-3995-7662","position":9,"is_corresponding":false},{"id":1706856,"name":"Raffaele Campisi","orcid":"0000-0001-9305-6748","position":10,"is_corresponding":false},{"id":1706857,"name":"Nunzio Crimi","orcid":null,"position":11,"is_corresponding":false},{"id":1158912,"name":"Claudia Crimi","orcid":"0000-0002-9088-5214","position":12,"is_corresponding":false},{"id":1621564,"name":"Girolamo Pelaia","orcid":"0000-0001-9288-8913","position":13,"is_corresponding":false},{"id":1621558,"name":"Corrado Pelaia","orcid":"0000-0002-4236-7367","position":14,"is_corresponding":false},{"id":1706847,"name":"Chiara Lupia","orcid":"0009-0004-8786-3489","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Short-Term Effects of Dupilumab in Eosinophilic COPD","abstract":"<jats:p>Background/Objectives: Patients with eosinophilic chronic obstructive pulmonary disease (COPD) often remain symptomatic despite optimized triple inhaled therapy. Dupilumab is a fully human monoclonal antibody that blocks the IL-4 receptor alpha subunit, thereby inhibiting IL-4 and IL-13 signaling. Evidence from randomized trials supports dupilumab for add-on treatment of type 2-high COPD, but data referring to short-term effectiveness in clinical practice are quite limited. Methods: We conducted an observational, compassionate-use study enrolling 13 consecutive outpatients with eosinophilic COPD (blood eosinophils ≥ 300 cells/µL) receiving add-on biologic therapy with dupilumab 300 mg every two weeks. Clinical (CAT, mMRC), functional (spirometry and body plethysmography), and inflammatory parameters (blood eosinophils/basophils, fibrinogen, FeNO) were evaluated at baseline and after four weeks of treatment. Safety was monitored after injection in a clinical setting, as well as via weekly phone follow-up. Results: Participants (84.6% male; mean age 67.08 ± 11.42 years) experienced rapid and clinically meaningful improvements at four weeks. CAT score decreased from baseline 21.40 ± 6.22 to 14.00 ± 5.58 (p &lt; 0.001) and mMRC scale from 2.90 ± 0.73 to 1.80 ± 0.63 (p &lt; 0.0001), respectively. Pre-bronchodilator FEV1 increased from baseline 1.35 ± 0.65 L to 1.59 ± 0.84 L (p &lt; 0.05), and FVC from 2.36 ± 0.92 L to 2.83 ± 1.11 L (p &lt; 0.01). A marked lung deflation was observed: indeed, residual volume declined from baseline 4.17 ± 1.98 L to 3.47 ± 2.07 L (p &lt; 0.05), with a concomitant reduction in specific effective airway resistance (from baseline 3.15 ± 1.77 to 2.43 ± 1.44 kPa·s; p &lt; 0.05) associated with significant increases in mid-expiratory flow (FEF25−75: from baseline 0.62 ± 0.38 to 0.86 ± 0.71 L/s; p &lt; 0.05) and peak expiratory flow (3.80 ± 1.40 to 4.48 ± 1.79 L/s; p &lt; 0.01). Type 2 inflammatory biomarkers changed as follows: blood eosinophil count fell from baseline 390.0 ± 43.75 to 190.0 ± 65.47 cells/µL (p &lt; 0.001); blood basophil number decreased from baseline 37.50 ± 13.89 to 26.25 ± 13.02 cells/µL (p &lt; 0.001); plasma fibrinogen lowered from baseline 388.4 ± 54.81 to 334.9 ± 72.36 mg/dL (p &lt; 0.01); FeNO levels dropped from baseline 23.95 ± 18.10 to 14.00 ± 2.04 ppb (p &lt; 0.0001). Dupilumab was well tolerated, and no treatment-related serious adverse events or discontinuations were detected. Conclusions: Within an exploratory context of daily medical activity referring to eosinophilic COPD already treated with maximal inhaled therapy, we found relevant therapeutic effects of a four-week add-on treatment with dupilumab. In particular, our patients manifested rapid improvements in symptoms, airflow limitation, and lung hyperinflation, paralleled by significant decrements of type 2 inflammatory signatures. Such encouraging results were associated with a favorable short-term safety profile. However, larger and longer studies are necessary to corroborate these preliminary findings.</jats:p>","is_dataset_classified":null,"base_score":0.0,"endowment":0.0,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"41598712","pmcid":"PMC12842441","openalex_id":null,"authors":[],"funders":[],"total_grants":0,"fwci":null,"citation_percentile":null,"influential_citations":0,"citation_trend":[],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://www.mdpi.com/2077-0383/15/2/775/pdf?version=1768718695","host_type":"publisher"},{"url":"https://www.mdpi.com/2077-0383/15/2/775/pdf","host_type":"publisher"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12842441/","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC12842441","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC12842441?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":[],"mesh_terms":[],"keywords":["Clinical practice","chronic obstructive pulmonary disease","Type 2 Inflammation","Dupilumab","Eosinophilic Copd"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-11T03:06:17.169146Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}