Pharmacists Play Essential Role in Managing Dupilumab for Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in the United States, with over 16 million adults with the disease—and many more who may not know they are afflicted.¹

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COPD can greatly reduce quality of life among patients, causing symptoms such as coughing, wheezing and shortness of breath, which can make everyday activities such as walking or going up stairs cumbersome and painful.

As there is no cure for the disease, strong treatment options are essential to mitigating the effects on patients. Recently, dupilumab (Dupixent; Sanofi, Regeneron), a fully human monoclonal antibody, has emerged as a potential path to producing clinical benefits in patients with COPD.

Dupilumab blocks the shared receptor component for IL-4 and IL-13 pathways that drive type 2 inflammation by promoting high eosinophil counts and increasing inflammatory infiltrates in the lungs.²

Multiple studies of dupilumab for COPD, specifically for those with type 2 inflammation, have confirmed its effectiveness in this setting. In a 2023 study, Bhatt et al assigned 939 patients with type 2 inflammation COPD in a randomized fashion to receive dupilumab or a placebo.²

They found that the annualized rate of moderate or severe COPD exacerbations was 0.78 (95% CI, 0.64-0.93) with dupilumab and 1.10 (95% CI, 0.93 to 1.30) with a placebo. Ultimately, they observed that among these COPD patients with high blood eosinophil levels, dupilumab led to fewer exacerbations, less severe respiratory symptoms and better quality of life compared to those receiving placebo.²

In a confirmatory follow-up study published recently, Bhatt et al aimed to solidify the efficacy and safety of dupilumab in this population. A total of 935 patients were assigned in a randomized fashion to either a dupilumab or placebo group.³

The annualized rate of moderate or severe exacerbations was 0.86 (95% CI, 0.70 to 1.06) with dupilumab and 1.30 (95% CI, 1.05 to 1.60) with placebo, affirming dupilumab’s effectiveness in treating COPD.³

Beyond positive clinical trial results, the role of pharmacists in providing patients accurate information and guiding them through treatment is essential. Pharmacists play an important part in ensuring patients adhere to their treatment plan and adopt lifestyle changes to improve quality of life in patients with COPD.⁴

One key hurdle for patients could be the subcutaneous administration of dupilumab. There may be concerns among key stakeholders, such as parents or caregivers of children with COPD or the elderly, regarding this method of treatment. Additionally, pharmacists may have their own concerns of administering this treatment if they don’t feel educated enough on the treatment process.

Monica Dougherty, PharmD, BCACP, a clinical pharmacy specialist at the University of Rochester, addressed these concerns in the context of administering dupilumab for atopic dermatitis. If parents have concerns with their children receiving this injection, “oftentimes, dupilumab injections can be administered in pharmacies," and if a family lives far from a pharmacy, “they can often receive treatments in pediatric offices instead,” she told Pharmacy Times^®.⁵

Even if a patient with COPD begins treatment with dupilumab, it is possible they may still be on other medications to treat the disease. Polypharmacy is common among patients who have COPD—14% take 5 or more medicines, with this percentage skyrocketing to 50% for hospitalized older patients.⁴

Polypharmacy can also lead to an increased risk of adverse drug events (ADEs), which are associated with acute exacerbations of COPD.⁴ Pharmacists must be diligent in reviewing and managing their patient’s list of medications and ensuring that medications leading to ADEs are discontinued. Additionally, they must work with the patient and evaluate their condition to find the medication that works best for their care.

Pharmacists also play an essential role in ensuring treatment adherence. For dupilumab to be effective in decreasing acute exacerbations of the disease, pharmacists must ensure that they are being proactive in their patient’s care and educating them about the importance of keeping up with their medication schedule. By being a motivator for their adherence to treatment, pharmacists can play an active role in their patient’s care.⁴

Medication reconciliation is inherently linked to these issues. When patients are prescribed multiple medications, it becomes more likely for discrepancies between therapies to arise which could adversely affect patient outcomes. Reconciliation can support the safe use of therapies and reduce medication errors. It’s up to pharmacists to make the effort to communicate with patients and develop a patient-centered approach to drug prescription management.⁴

Overall, “pharmacists play an important role in managing drug therapy and are integral members of healthcare professional teams,” Dougherty said. She added that pharmacists “can improve patient convenience, enable timely diagnosis of COPD by screening at-risk individuals, optimize drug therapy selection,” as well as help maintain the long-term management of therapy in patients.⁴

Pharmacists always play an important role in treatment management, but with the potential of dupilumab to make a huge impact in reducing exacerbations associated with COPD and increasing quality of life, it is more critical than ever for pharmacists to be educated and prepared to recommend dupilumab for the patients that need it.

Dupilumab could be a game-changer for patients with COPD and provide a new treatment pathway for patients who desperately need it. Only with pharmacists educating themselves, working with patients to optimize their care plans, and collaborating with fellow pharmacists and physicians can dupilumab be used to its full effectiveness.

References

1. Centers for Disease Control and Prevention. Chronic obstructive pulmonary disease (COPD) – About COPD. Updated May 15, 2024. Accessed July 1, 2024. https://www.cdc.gov/copd/about/index.html

2. Bhatt S, Rabe K, Hanania N, et al. Dupilumab for COPD with type 2 inflammation indicated by eosinophil counts. N Engl J Med. 2023;389(3):205-214. doi:10.1056/NEJMoa2303951

3. Bhatt S, Rabe K, Hanania N, et al. Dupilumab for COPD with blood eosinophil evidence of type 2 inflammation. N Engl J Med. 2024;390(24):2274-2283. doi:10.1056/NEJMoa2401304

4. Hudd T. Emerging role of pharmacists in managing patients with chronic obstructive pulmonary disease. Am J Health Syst Pharm. 2020;77(19):1625-1630. doi:10.1093/ajhp/zxaa216

5. McGovern G. Pharmacists play crucial role in dupilumab treatment for infants, young children with atopic dermatitis. Pharmacy Times. June 12, 2024. Accessed July 1, 2024. https://www.pharmacytimes.com/view/pharmacists-play-crucial-role-in-dupilumab-treatment-for-infants-young-children-with-atopic-dermatitis