Biologics lower exacerbations, hospitalizations in COPD, Th2 inflammation
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Key takeaways:
- This study population represents patients with COPD and Th2 inflammation that clinicians treat daily.
- Included patients had comorbidities such as emphysema and airflow obstruction.
SAN DIEGO — After 1 year of biologic therapy, patients with COPD and Th2 inflammation experienced fewer exacerbations and hospitalizations, according to research presented at the American Thoracic Society International Conference.
“Because we took a real-world approach including all comers with COPD who received biologics, this may be more directly relatable to patients at large and patients being treated by clinicians, primary care doctors and pulmonologists every day in the community,” Stephen R. Dachert, MD, a fellow in the department of thoracic medicine and surgery at Temple University Hospital, told Healio.
In a real-world, single-center, retrospective review, Dachert and colleagues evaluated 53 patients (mean age, 70.7 years; 58% women) with COPD and Th2 inflammation and a biologic prescription to find out how 1-year biologic use impacts acute exacerbations of COPD and lung function.
Before starting biologic therapy, the average eosinophil count was 471 cells/µL.
The most prescribed biologic in this cohort was mepolizumab (n = 40; 66.7%; Nucala, GSK), followed by benralizumab (n = 14; 23.3%; Fasenra, AstraZeneca), dupilumab (n = 5; 8.3%; Dupixent; Regeneron, Sanofi) and tezepelumab (n = 1; 1.7%; Tezspire; Amgen, AstraZeneca).
Notably, this sample included patients with mild to severe emphysema and patients with airflow obstruction, which Dachert said are both underrepresented in randomized clinical trials.
This cohort was also diverse in race/ethnicity, including white patients (65%), Black/African American patients (20%), Hispanic patients (8.4%) and patients from other racial/ethnic groups (6%).
“Being from Temple, we are lucky that we have a very diverse patient population, which oftentimes is not the case in a lot of large, randomized clinical trials,” Dachert said.
Compared with the number of exacerbations observed 1 year prior to biologic therapy use, researchers found that 1 year of biologic therapy significantly lowered the number of exacerbations by 1.883 (95% CI, 1.382-2.385).
Further, 1 year of biologic use also led to a significant decrease in the number of hospitalizations vs. the year before biologic use (0.783; 95% CI, 0.427-1.14).
“The big takeaway in our large, real-world study of diverse patients with a lot of comorbidities, including emphysema and high exacerbation burden, is that we showed a statistically significant reduction in both moderate and severe exacerbations, including hospitalizations,” Dachert said. “Specifically, the hospitalization finding has not been shown before, so we are novel in showing that.”
To observe changes in spirometry following biologic therapy use, researchers assessed several measures of percent-predicted lung function: FEV1, FVC, total lung capacity, residual volume and diffusing capacity of the lungs for carbon monoxide (DLCO).
For all the above measures, the difference between 1 year before and 1 year after biologic therapy use did not reach significance. The only measure of lung function that “trended towards significance” was an increase in DLCO, according to researchers.
Considering the real-world aspect of this study, Dachert emphasized the value of the main findings for clinicians.
“This information would be very useful to general clinicians and pulmonologists in that they may find that their patients look more like the patients that we looked at in our study,” he said.
Future studies on this topic should strive to include more patients, Dachert told Healio.
“In this study, we looked at things like emphysema and varying degrees of airflow obstruction and saw that there was no statistical difference in exacerbations in those specific groups,” Dachert said. “Moving forward, if we’re able to increase the amount of data that we have, we may be able to identify some kind of variable that would be associated with an even higher reduction in exacerbations.”