BACKGROUND: The body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index predicts 5-year mortality risk in chronic obstructive pulmonary disease (COPD)
higher scores predict worse outcomes. Dupilumab, a fully human monoclonal antibody that blocks the shared receptor component for interleukin-4/13, reduced exacerbations and improved lung function in patients with COPD in phase 3 BOREAS trial (NCT03930732). We assessed dupilumab efficacy in patients with COPD and type 2 inflammation by baseline BODE index. METHODS: Patients with COPD, moderate-to-severe airflow limitation, screening blood eosinophils ≥300 cells/μL, and high exacerbation risk, on triple therapy, received 300-mg add-on dupilumab or placebo every 2 weeks for 52 weeks. Annualized moderate or severe COPD exacerbation rate and change from baseline in pre-bronchodilator forced expiratory volume in 1 second (FEV RESULTS: Of 934 patients with reported baseline BODE index scores (dupilumab: 470
placebo: 464), 61.8% had scores ≤4. Dupilumab reduced exacerbations versus placebo, regardless of baseline BODE index group. Exacerbation reductions were similar by BODE index group
relative risk (95% confidence interval) for patients with BODE index >
4 versus ≤4 was 0.656 (0.496-0.868) versus 0.718 (0.547-0.944). At Weeks 12 and 52, dupilumab consistently improved pre-bronchodilator FEV CONCLUSION: Dupilumab reduced exacerbations and improved lung function in patients with COPD and type 2 inflammation irrespective of baseline BODE index score. CLINICAL TRIAL REGISTRATION NUMBER: BOREAS trial NCT03930732.