2024-07-23 17:00:00
Referred to as the “silent killer,” chronic obstructive pulmonary disease (COPD) is a lung disease characterized by inflammation and progressive obstruction of the bronchi.
In France, 5 million individuals are affected by COPD, two-thirds of whom are unaware that they have the disease. In 85% of cases, tobacco plays a central role in the onset of this disease, which should not overshadow other causes, such as indoor, industrial, and atmospheric pollutants.
Awaiting New Treatments
The use of bronchodilators, prevention of respiratory infections through vaccination, and appropriate physical activity are the therapies currently available.
Bronchodilators provide respiratory comfort and prevent crises that worsen the disease (“exacerbations,” which require systemic corticosteroid treatment and/or hospitalization), but they are far from sufficient.
As a result, there is strong anticipation for discovering new medications, not only to reduce the occurrence of exacerbations but also, hopefully, to improve respiratory capacity.
The challenge was therefore significant for dupilumab, a biologic medication that has already proven effective in six other diseases where type 2 inflammation (characterized by a high number of eosinophils, a type of white blood cell involved in immune responses) plays a predominant role: atopic dermatitis (atopic eczema), asthma, nasal polyps, nodular prurigo, eosinophilic esophagitis, and chronic spontaneous urticaria, following the failure of conventional treatments.
Specifically, dupilumab is a fully human monoclonal antibody that inhibits key factors in the inflammatory response (here interleukins 4 and 13), without immunosuppressive effects.
Less Exacerbations and Increased Respiratory Capacity
Data from the phase 3 clinical study (NOTUS, involving 935 patients) have been published and presented simultaneously at the 2024 American Thoracic Society (ATS) International Congress (San Diego, May 17-22, 2024).
In individuals suffering from COPD (with a blood eosinophil count of 300 cells per microliter or greater), this biotherapy would reduce the risk of exacerbations by one-third.
Consistent with the results of a previous phase 3 study published in 2023, moderate and severe exacerbations are reduced by an average of 34% when the medication is administered for 52 weeks in combination with bronchodilators and corticosteroids.
The annual rate of exacerbations is 0.86 in the dupilumab-treated group compared to 1.30 in the placebo group.
Additionally, an improvement in respiratory function was observed, with an increase in the Forced Expiratory Volume in one second (FEV1): the amount of air a person can exhale from their lungs in one second, of 82 ml (139 ml versus 57 ml) and 61 ml (115 ml versus 54 ml) at 12 and 52 weeks, respectively.
In parallel, quality of life scores and respiratory symptom severity scores were better under biotherapy. There were no safety alerts concerning its use.
30,000 to 60,000 Patients Affected
Potentially, 30,000 to 60,000 French patients could benefit from the treatment. Dupilumab thus has the potential to become the first new medication for the treatment of COPD in over ten years, as well as the very first targeted medication for this indication.
Presentation at ATS and publication in NEJM of the latest data from the confirmatory phase III NOTUS study regarding Dupixent® in the treatment of COPD; Surya P. Bhatt, Klaus F. Rabe, Nicola A. Hanania et al. Dupilumab for COPD with Blood Eosinophil Evidence of Type 2 Inflammation Published May 20, 2024; DOI: 10.1056/NEJMoa2401304
Future Trends in COPD Treatment: A Look Ahead
Chronic Obstructive Pulmonary Disease (COPD), often referred to as the “silent killer,” affects millions in France, with around 5 million individuals living with this debilitating condition. As awareness grows about the disease, particularly the significant role of tobacco usage, the spotlight on alternative treatment strategies continues to increase.
Advancements in Biologics
Exciting developments are on the horizon with biologic therapies, especially dupilumab, which has already achieved promising results in treating various inflammatory diseases. Recent clinical trials indicate that dupilumab has the potential to reduce exacerbation rates by one-third in COPD patients while also improving lung function. This could signal a new era in COPD management, where targeted biologic therapies become a cornerstone of treatment, moving beyond traditional medications like bronchodilators and corticosteroids.
Shifting Treatment Paradigms
The evolving landscape of COPD treatment suggests a shift towards personalized medicine. Identifying specific patient populations—such as those with elevated eosinophil levels—may help tailor therapies to maximize efficacy. As biologic treatments gain traction, there could be a significant focus on early diagnosis and intervention strategies that leverage these targeted therapies. This approach aims not only to reduce symptoms but also to mitigate long-term disease progression.
Integrating Lifestyle Modifications
In addition to pharmacological advancements, lifestyle modifications will play a crucial role in the future management of COPD. Emphasizing physical activity and respiratory rehabilitation can complement pharmacotherapy, helping patients manage their symptoms and improve their quality of life. Educational initiatives aimed at increasing public awareness of COPD will be critical in encouraging healthier lifestyle choices and smoking cessation.
Future Research Directions
Future research is poised to explore further the efficacy of new treatment modalities, especially in how they integrate with existing therapies. With the potential of dupilumab and similar biologics being recognized, ongoing studies will likely focus on long-term outcomes, optimal dosing strategies, and patient-centric approaches that enhance overall care. Greater collaboration between researchers, healthcare providers, and patients will be essential to refine treatment options and ensure they meet the needs of those living with COPD.
As COPD’s impact becomes increasingly recognized and addressed, the future of treatment is promising, offering hope to both patients and healthcare providers in the fight against this chronic condition.