Use of Systemic Corticosteroids and Antibiotics in Patients with Chronic Obstructive Pulmonary Disease (COPD) and Type 2 Inflammation Receiving Dupilumab

Rationale: In BOREAS and NOTUS, add-on dupilumab vs placebo reduced moderate or severe exacerbation rates and improved lung function in patients with chronic obstructive pulmonary disease (COPD) and type 2 inflammation. Systemic corticosteroids (SCS) and antibiotics are often prescribed together for relief of COPD exacerbations. This post hoc analysis pooled data from the BOREAS and NOTUS trials to evaluate whether dupilumab reduced the burden of SCS and antibiotic use, compared with placebo, in patients with COPD and type 2 inflammation. Methods: BOREAS (NCT03930732) and NOTUS (NCT04456673) were phase 3, randomized, placebo-controlled trials in which patients with COPD, moderate-to-severe airflow limitation, and type 2 inflammation, on triple therapy, were randomized to dupilumab 300 mg or placebo every 2 weeks for 52 weeks. This analysis evaluated SCS and antibiotic use for patients in the intention-to-treat population with≥1 moderate or severe exacerbation within 1 year prior to baseline or during the 52-week treatment period. Results: For patients with≥1 moderate or severe exacerbation within 1 year prior to baseline (dupilumab: n=937; placebo n=936), the annualized total SCS intake duration (mean [SD]) was 17.5 (25.2) and 21.9 (33.8) days for dupilumab and placebo ( P =0.05), respectively, and annualized total antibiotic intake duration (mean [SD]) was 24.6 (55.3) and 26.9 (56.8) days for dupilumab and placebo ( P =0.56), respectively. For patients with≥1 moderate or severe exacerbation during the 52-week treatment period (dupilumab: n=338; placebo: n=394), annualized total SCS intake duration (mean [SD]) was 16.1 (22.1) and 22.2 (34.1) days for dupilumab and placebo ( P =0.008), respectively, and annualized total antibiotic intake duration (mean [SD]) was 23.0 (49.2) and 24.8 (49.4) days for dupilumab and placebo ( P =0.67), respectively. Safety of dupilumab was consistent with the known dupilumab safety profile. Conclusions : In BOREAS and NOTUS, dupilumab vs placebo reduced exacerbation events and decreased the cumulative number of days exposed to SCS or antibiotic, despite differences in exacerbation clinical treatment practices and regardless of whether patients exacerbated during or within the year prior to the study period. Publication History Article published online: 04 March 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany