Early Lung Function Gains With Dupilumab Linked to Long-Term COPD Outcomes, With Nicola Hanania, MD, MS

The treatment landscape for chronic obstructive pulmonary disease (COPD) has long centered on preventing exacerbations and slowing the relentless progression of lung function decline. While current inhaled therapies and biologics have improved patient outcomes, clinicians remain challenged by the variability of disease expression and the difficulty of predicting long-term benefit from new treatments. Recent data with dupilumab, an IL-4/IL-13 pathway–targeting biologic, offer important insight into how early improvements in lung function may translate into sustained outcomes, including reduced exacerbation rates and improved quality of life.

In a new post hoc analysis of the phase 3 NOTUS and BOREAS trials presented at the European Respiratory Society (ERS) Congress 2025, held September 27 to October 1 in Amsterdam, Netherlands, investigators examined whether lung function gains seen as early as 4 weeks after treatment initiation could predict reductions in exacerbations over 1 year, as well as improvements in patient-reported outcomes. HCPLive spoke with Nicola A. Hanania, MD, MS, professor of medicine and director of the Asthma Clinical Research Center at Baylor College of Medicine, who has been at the forefront of research into dupilumab’s role in COPD management and served as study investigator on the trials. The findings showed that early lung function improvement was modestly but significantly correlated with both reduced exacerbation risk and enhanced quality-of-life scores, offering a potential new tool for clinicians in monitoring treatment response.

For physicians, this analysis highlights an important shift. COPD management has often relied on retrospective markers, such as exacerbation history, to guide therapy escalation. If early, objective measures like forced expiratory volume can serve as reliable indicators of long-term benefit, clinicians may be better equipped to identify responders sooner, optimize biologic use, and personalize treatment strategies. In this interview, Hanania discussed the rationale for investigating early lung function improvements, the implications for clinical practice, and what these findings may mean for the broader goal of improving outcomes in COPD.

"Post hoc analyses have to always be looked at with a grain of salt, but it's an important addition to what we know. It also reinforces the knowledge that lung function improvement is an important thing to to work for to improve in the management of COPD... we sometimes say these patients have fixed airway obstruction. We can't move the needle. That's not true. We can improve lung function, and indeed, in our analysis, it sounds like those who have improvement lung function as early as 4 weeks had also reduction exacerbation and improvement in symptoms," Hanania said.

Hanania's disclosures include Sanofi, Genzyme, Regeneron, GSK, AstraZeneca, Regeneron, Genentech, and Merck.

Reference

Media Update: ERS: new data across Sanofi’s immunology pipeline reinforce leadership in respiratory diseases. News release. Sanofi. September 4, 2025. https://www.sanofi.com/en/media-room/press-releases/2025/2025-09-04-05-30-00-3144180