Many people with COPD can control their symptoms by using inhaled medicines each day. But inhaled medicines may not offer enough relief for people who also have high levels of a type of white blood cell called an eosinophil.
Many new medicines that work directly on the body’s immune system are being studied for the treatment of COPD. In 2024, Dupixent became the first of these medicines to be approved for COPD. This medicine may be an option for people who have COPD and also have high eosinophil levels.
How Does Dupixent Work for COPD?
COPD is a long-term (chronic) condition of the lungs that can make it hard to breathe. COPD is an umbrella term that includes two conditions: emphysema and chronic bronchitis. Some people with COPD have emphysema, some have chronic bronchitis, and some have both. In emphysema, the air sacs in the lungs become damaged and are less able to pass oxygen into the bloodstream. Air can also become trapped in the damaged air sacs, making it harder to breathe over time. In chronic bronchitis, swelling (inflammation) causes the airways to become narrowed. It also causes mucus to build up, clogging the airways.
People with mild COPD may not have symptoms. But COPD is a progressive condition, which means that symptoms will get worse with time. As COPD worsens, symptoms can include coughing, bringing up mucus, trouble breathing or taking a deep breath, wheezing, and tightness in the chest.
People with COPD may experience a flare-up (or exacerbation). These flare-ups, which can be mild to severe, can last for days to weeks and may involve coughing more often, bringing up more mucus, having more trouble breathing, and feeling more tired. Although flare-ups have many causes, some are caused by certain “triggers”, such as:
- Cold air
- Dust
- Infections
- Pollen
- Smoking or inhaling smoke
- Strong smells
- Sudden temperature changes
The keys to treating COPD are to control symptoms, reduce the amount of swelling in the lungs, and open up the airways. This helps make it easier to breathe. Many of the medicines used for COPD are inhaled into the lungs, and most people with this condition will use two to three inhaled medicines every day. But this may not offer enough relief for people who have high levels of eosinophils. People with high eosinophil levels may have more trouble controlling their COPD symptoms.
The active ingredient in Dupixent is a medicine called dupilumab, which works by blocking certain proteins that send immune system signals in the body (interleukin-4 and interleukin-13). Blocking these proteins helps to reduce swelling in the lungs in people with COPD and high eosinophil levels.
How Do I Use It?
Dupixent is a liquid that is injected under the skin every two weeks. It can be injected into the thigh, stomach, or outer area of the upper arm. This medicine comes as a prefilled device that is ready to be injected under the skin, so you do not need to learn how to use a syringe and needle.
It is important to inject the medicine properly so that you get the right dose. Your health care provider will show you how to inject the medicine before you use it the first time. Your prescription should also come with “Instructions for Use,” which explain how to prepare and give a dose. Ask your pharmacist or other health care provider if you are unsure how to use Dupixent.
If you miss a dose of this medicine, you should use the missed dose as soon as you remember if it has been less than 7 days since the missed dose. If it has been more than 7 days, skip the missed dose and use your next dose on the regularly scheduled day.
How Was It Studied for Treating COPD?
Two clinical studies were done to see if Dupixent was safe and effective for treating COPD. Everyone had high eosinophil levels and still had difficult symptoms even though they were using three inhaled medicines each day. On average, the people in this study had experienced two moderate to severe flare-ups in the year before the study started. Here is some other important information about the people in these studies:
- Everyone was at least 40 years old, with an average age of 65.
- Most (67%) were male. Most (87%) were White, about 8% were Asian, about 3% were American Indian or Alaska Native, less than 1% were Black, and less than 1% were Native Hawaiian or other Pacific Islander.
- About 30% identified as Hispanic or Latino.
- Everyone had smoked at some point in the past, and about one-third (30%) were still smoking when the study started.
These studies compared Dupixent with a placebo, and no one knew whether they were receiving the medicine or the placebo. Everyone was told to continue using their inhaled medicines every day during the study.
Both studies measured effectiveness by counting the number of moderate or severe COPD flare-ups (exacerbations) that happened during the year in the study.
- A “moderate” exacerbation meant that a person needed to be treated with an oral corticosteroid (such as prednisone) or an antibiotic.
- A “severe” exacerbation meant that a person was admitted to the hospital or needed to stay in the emergency department (ER) for at least one full day and night.
These studies also measured how well each person’s lungs were working during the study. This was done by asking people to take a deep breath and then force as much air out of their lungs as possible. The amount of air that a person could force out of their lungs in one second was recorded.
What Benefits Were Seen in These Studies?
COPD exacerbations. During the year in the study, the people who used Dupixent had fewer moderate or severe COPD exacerbations than the people who used a placebo. This means that people who used Dupixent were less likely to have serious COPD flare-ups.
Breathing function. During the study, the people who used Dupixent were able to force more air out of their lungs than the people who used placebo. This started within the first month of treatment and continued for the full year of the study. This means that people who used Dupixent were able to move air through their lungs more easily.
How Quickly Will Dupixent Work for COPD?
If Dupixent is working, you should have less trouble breathing within the first month of using the medicine. Over time, this might mean that you will have fewer COPD exacerbations that require treatment with oral medicines or require you to stay in the hospital or the ER.
If I Use Dupixent, Will I Still Need to Use My Inhalers?
Dupixent is meant to be used together with your daily inhalers to help control your COPD symptoms. You should not stop using any of your regular inhaled medicines without talking to your health care provider first, even if your breathing has gotten better. You should also not lower the dose of any of your other medicines without talking to your health care provider first. Your breathing and symptoms may get worse again if you stop or change any of your medicines.
In addition to daily inhaled medicines, you should always have access to a rescue inhaler such as albuterol. These inhalers give quick relief of symptoms and should be used when you are having sudden trouble breathing. Dupixent must be used on a regular basis so that it can help to prevent COPD symptoms. It should not be used to manage sudden breathing issues.
What Are Possible Side Effects, and How Can I Prevent Them?
In some people, Dupixent can cause a skin reaction where the needle went in the skin, which may involve redness, pain, swelling, and bruising. These reactions are most common after the first dose but can happen with later doses as well. The best way to decrease these reactions is to inject the drug into a different part of the body each time, which is called rotating the injection site. For example, the medicine can be injected into different parts of the thigh, stomach, or outer area of the upper arms. Don’t inject the drug into skin that is already tender, damaged, bruised, or scarred.
Dupixent may cause eosinophil levels to increase in some people. In most cases, these higher eosinophil levels (eosinophilia) do not cause any symptoms and do not need to be treated. These levels drop back down to normal in most people who use this medicine. In very rare cases, high eosinophil levels can cause new swelling in the lungs or blood vessels. You should contact your health care provider right away if your breathing problems get worse or if you develop a rash, numbness, or tingling in the arms and legs or a fever.
These are not all of the possible side effects. Talk with your health care provider if you are having symptoms that bother you. If you experience anything that you think may be caused by Dupixent, you can also report side effects to the FDA at 800-FDA-1088.
Are There Any Interactions With Other Medicines?
There are no known interactions between Dupixent and other medicines. But it is still important for your health care provider to be aware of all the prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, or other supplements you take or have recently taken.
Are There Any Interactions With Vaccines?
It is important to discuss any recent or upcoming vaccines (immunizations) with your health care provider. There are certain vaccines (“live” vaccines) that you should not receive either right before starting Dupixent or once you have already started it. Your health care provider will confirm whether any recent or upcoming vaccines are safe.
Are There Any Special Steps Required to Get This Medicine?
Dupixent is a type of medicine called a “specialty” medicine. This means that you can only get it from a specialty pharmacy, which may need to ship the medicine to you. This also means that it may require prior authorization from your insurance company. You can find out more about this at www.dupixent.com/support-savings/dupixent-my-way.
Is There a Coupon Card Available?
There is a savings coupon available from the drugmaker that may allow you to pay $0 for your prescription. Whether you are eligible depends on whether you have prescription insurance and what type of insurance you have. You can find out more at www.dupixent.com/support-savings/copay-card.
