Abstract Rationale Dupilumab and mepolizumab have been shown to reduce the risk of moderate-severe exacerbations in patients with COPD who have evidence of type 2 inflammation in clinical studies. Whether these treatment benefits are generalizable to the real-world population is unknown. Methods We utilized the TriNetX database United States collaborative network, a globally federated database that comprises of electronic health records and billing claims across 160 healthcare organizations, to perform a retrospective cohort study. Using Current Procedural Terminology (CPT), International Classification of Diseases 10th revision (ICD-10) and Anatomical Therapeutic Chemical (ATC) codes, we categorized patients into two cohorts; patients with COPD or Asthma/COPD Overlap Syndrome (ACOS) who received either mepolizumab or dupilumab from October 2023-October 2025 and patients with COPD or Asthma/COPD overlap who had never received either medication. ACOS has no universally accepted definition; patients were presumed to have ACOS if they had ICD-10 codes for COPD and asthma. Using baseline demographic data and comorbidity covariates, we performed a 1:1 propensity score matched analysis to identify independent associations of exacerbations of COPD. The primary outcome was acute exacerbation of COPD; secondary outcomes included the use of glucocorticoids or emergency visit/hospitalization. Results A total of 5,591 patients were in the biologic group, and 900,144 in the non-biologic group. After propensity scoring, each group consisted of 5,590. Patients who were on biologics had lower risk of being diagnosed with an acute exacerbation of COPD (26% vs 34% p value 0.0001; RR 0.766 CI 0.72-0.81). Patients on biologics also had lower risk of being prescribed glucocorticoids (74% vs 80% p value 0.0001 RR 0.925 CI 0.91-0.94) or presenting to the ER/hospitalization (43.4% vs 60.5% p value 0.0001 RR 0.718 CI 0.69-0.74). Conclusion Our real-world study indicates that the use of biologics in COPD or ACOS is associated with lower risk of exacerbation, need for glucocorticoids, and ER visit/hospitalization. This abstract is funded by: None
Shaikh et al. (Fri,) studied this question.