D3.428 - Substratification of Biologic Treatment Using Dupilumab in Eosinophilic COPD

Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a heterogeneous condition, with a subset of patients exhibiting predominant type 2 (T2) inflammation. We present the case of a 69-year-old patient with severe, progressive, steroid-dependent eosinophilic COPD and chronic respiratory failure, undergoing long-term oxygen therapy and awaiting lung transplantation. Despite maximal inhaled therapy (high-dose ICS/LABA/LAMA plus rescue SABA/SAMA), and maintenance oral corticosteroids, disease control remained poor with frequent exacerbation interventions.

Following GOLD 2025 guidelines and via the individual access pathway, dupilumab therapy was initiated on 05.08.2025. Within 20 weeks, and with combined dose of 3000 mg of dupilumab administered, clinical improvement (CAT, mMRC, 6MWT) and reduction in FeNO was observed.

These findings confirm the anti-inflammatory effect of dupilumab on the T2 pathway, and suggest a real therapeutic effect despite unchanged FEV1. It shows the potential of dupilumab as a therapy for patients with the T2-high COPD phenotype, consistent with the results of large phase III trials (BOREAS, NOTUS), as well as a “bridge therapy” for transplant candidates, reducing exacerbations and improving functional capacity.

This case supports IL‐4/IL‐13 blockade as a precision medicine strategy for T2-high COPD, illustrating the translational potential of precisely personalised medicine, and targeted biologics in off-label contexts and advocating for expanded biological therapy criteria in Poland.