A German multicenter study shows that the antibody dupilumab can significantly reduce the frequency of acute exacerbations in people with chronic obstructive pulmonary disease (COPD) and type 2 inflammation. The study was initiated by the Airway Research Center North (ARCN) within the German Center for Lung Research (DZL) and conducted in collaboration with the other four DZL sites and additional specialist respiratory and university hospitals across Germany.
In COPD, the airways are permanently narrowed, often causing shortness of breath, coughing, and sputum production. Acute worsening of the disease, known as exacerbations, can significantly impair quality of life and necessitate hospitalization. For the study, a research team analyzed treatment outcomes in 99 patients from 14 specialized centers in Germany. Treatment with dupilumab substantially reduced the frequency of moderate-to-severe exacerbations. Patients also reported an improvement in their symptoms.
In some people with COPD, type 2 inflammation plays an important role. This type of inflammation can be identified, among other ways, through biomarkers such as the number of eosinophils in the blood. Dupilumab is a monoclonal antibody that blocks the signaling pathways of the messenger molecules interleukin-4 and interleukin-13, thereby specifically targeting these inflammatory processes. The efficacy of this treatment in COPD with type 2 inflammation has already been demonstrated in large clinical trials. However, data from routine clinical practice had not previously been available.
For the current study, the research team analyzed anonymized clinical data. The 99 patients included in the study had experienced recurrent exacerbations despite triple inhaled therapy and subsequently received dupilumab. Many already had advanced disease. During treatment, the annual rate of moderate-to-severe exacerbations decreased by 70 percent compared with the period before treatment began. Severe exacerbations requiring hospitalization also declined substantially. The findings suggest that dupilumab may help reduce the frequency of acute worsening in people with COPD and type 2 inflammation.
In addition to the frequency of acute exacerbations, the team investigated changes in symptoms and lung function. Patients reported improvements in their symptoms during treatment. Airway resistance also decreased. Overall, the changes in lung function were more moderate than the effects on exacerbation frequency. These findings therefore suggest that treatment may have a beneficial impact on both the burden of disease and certain physiological aspects of airway function.
The researchers also investigated whether treatment outcomes differed according to the clinical characteristics of the disease. The reduction in exacerbations was observed in patients with different COPD phenotypes, including those with coexisting asthma, chronic bronchitis, or pronounced pulmonary emphysema. No statistically significant differences in treatment effects were found between the subgroups analyzed. Further studies are needed to determine which factors influence the response to dupilumab.
“I am pleased that our study provides the first multicenter real-world data on the effectiveness of dupilumab in COPD. We demonstrate consistent effects across different clinical phenotypes, as well as positive effects on quality of life and lung function—outcomes that were not investigated in the same way in the pivotal clinical trials. This was made possible by close collaboration among numerous centers across Germany, including DZL sites and other hospitals,” says the study lead, Dr. Mustafa Abdo from University Hospital Schleswig-Holstein in Kiel.
For the first time, these findings complement evidence from clinical trials with data from routine clinical practice. They show that dupilumab was associated with a substantial reduction in acute exacerbations even in patients with partially advanced COPD and a high disease burden. As this was a retrospective study without a control group, further studies are needed to confirm the results. The study provides important insights into the potential of targeted therapies for COPD with type 2 inflammation. At the same time, it highlights the contribution of collaboration among researchers at all five DZL sites to investigating new therapeutic approaches and their effectiveness in real-world settings.
Original publication: Abdo M, Skowasch D, Greulich T, Drick N, Lommatzsch M, Hübner RH, Trinkmann F, Milger K, Rademacher J, Kontogianni K, Aetou M, Dreher M, Alter P, Pappe E, Biener L, Sander S, Heyckendorf J, Kahnert K, Götschke J, Neurohr C, Stolz D, Veith V, Watz H, Waschki B, Mertsch P. Real-world effectiveness of dupilumab in COPD: a German multicenter analysis. Respiratory Research. 2026 Oct 6;27(1):386. doi: 10.1186/s12931-026-03940-8. PMID: 42839285; PMCID: PMC13640210.
