Dupilumab for maintenance treatment of uncontrolled chronic obstructive pulmonary disease with raised blood eosinophils

Dupilumab can be used as an add-on maintenance treatment option for uncontrolled chronic obstructive pulmonary disease (COPD) with raised blood eosinophils in adults if:

• they are having:

  • triple therapy including an inhaled corticosteroid, a long-acting beta2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), or

  • double therapy including a LABA and a LAMA if inhaled corticosteroids are not appropriate, and

• the company provides dupilumab according to the commercial arrangement.
  
  Uncontrolled COPD is defined as 1 or more severe exacerbations or 2 or more moderate exacerbations in the previous 12 months. Raised blood eosinophils is defined as a blood eosinophil count of 0.3 x 10^9 cells per litre or more (300 cells per microlitre or more).

Assess response to dupilumab at 12 months. Stop dupilumab if, compared with the 12 months before starting it, the number of severe exacerbations:

• is higher, or

• is the same, and the number of moderate exacerbations is higher.

These recommendations are not intended to affect treatment with dupilumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.