Comparative Real-World Effectiveness of Dupilumab, Mepolizumab, and Benralizumab in Patients with Chronic Obstructive Pulmonary Disease: A Propensity Score-Matched Cohort Study.
9 affiliations
- 1Department of Internal Medicine, Chi Mei Hospital, Chiali, Taiwan.
- 2Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan.
- 3Department of General Medicine, Chi Mei Medical Center, Tainan, Taiwan.
- 4Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan.
- 5Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- 6Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
- 7Respiratory Medicine Department, University of Ioannina, Ioannina, Greece.
- 8Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.
- 9School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan.
Abstract
Background
Dupilumab, mepolizumab, and benralizumab have each demonstrated efficacy in placebo-controlled trials for chronic obstructive pulmonary disease (COPD) with type 2 inflammation. However, no head-to-head trials or real-world comparative effectiveness studies have been reported. We aimed to compare the effectiveness of dupilumab, mepolizumab, and benralizumab in patients with COPD using propensity score-matched cohort analyses.Design
Retrospective cohort study using the TriNetX US Collaborative Network.Methods
Adults with COPD initiating dupilumab, mepolizumab, or benralizumab between 2022 and 2025 were identified. Biologic-naive new users were included in two pairwise comparisons: dupilumab versus mepolizumab and dupilumab versus benralizumab. Propensity score matching (1:1) balanced baseline characteristics. The primary outcome was COPD exacerbation; secondary outcomes included acute respiratory failure, pneumonia, and bronchitis over 365 days. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards models.Results
Propensity score matching identified 3078 dupilumab-mepolizumab pairs and 2109 dupilumab-benralizumab pairs. Compared with mepolizumab, dupilumab was associated with a numerically lower risk of COPD exacerbation (HR, 0.76; 95% CI, 0.57-1.01) and a significantly lower risk of bronchitis (HR, 0.69; 95% CI, 0.49-0.98). No significant differences were observed between dupilumab and benralizumab for COPD exacerbation (HR, 0.98; 95% CI, 0.70-1.40), acute respiratory failure, pneumonia, or bronchitis.Conclusion
In this large real-world cohort study, no statistically significant difference in COPD exacerbation risk was observed between dupilumab and mepolizumab or between dupilumab and benralizumab. However, blood eosinophil counts and baseline lung function measurements were not available in the dataset, so residual confounding cannot be excluded.
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BibTeX
@article{liao2026comparative,
title = {{Comparative Real-World Effectiveness of Dupilumab, Mepolizumab, and Benralizumab in Patients with Chronic Obstructive Pulmonary Disease: A Propensity Score-Matched Cohort Study.}},
author = {Kuang-Ming Liao and Sheng-Chi Huang and Jheng-Yan Wu and Chia-Yu Kuo and Wan-Hsuan Hsu and Konstantinos Kostikas and Chih-Cheng Lai},
journal = {Drug design, development and therapy},
year = {2026},
month = oct,
doi = {10.2147/dddt.s647256},
url = {https://europepmc.org/article/MED/42928777},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Comparative Real-World Effectiveness of Dupilumab, Mepolizumab, and Benralizumab in Patients with Chronic Obstructive Pulmonary Disease: A Propensity Score-Matched Cohort Study.
AU - Kuang-Ming Liao
AU - Sheng-Chi Huang
AU - Jheng-Yan Wu
AU - Chia-Yu Kuo
AU - Wan-Hsuan Hsu
AU - Konstantinos Kostikas
AU - Chih-Cheng Lai
PY - 2026
DA - 2026/10/21
JO - Drug design, development and therapy
DO - 10.2147/dddt.s647256
UR - https://europepmc.org/article/MED/42928777
AB - Background Dupilumab, mepolizumab, and benralizumab have each demonstrated efficacy in placebo-controlled trials for chronic obstructive pulmonary disease (COPD) with type 2 inflammation. However, no head-to-head trials or real-world comparative effectiveness studies have been reported. We aimed to compare the effectiveness of dupilumab, mepolizumab, and benralizumab in patients with COPD using propensity score-matched cohort analyses.Design Retrospective cohort study using the TriNetX US Collaborative Network.Methods Adults with COPD initiating dupilumab, mepolizumab, or benralizumab between 2022 and 2025 were identified. Biologic-naive new users were included in two pairwise comparisons: dupilumab versus mepolizumab and dupilumab versus benralizumab. Propensity score matching (1:1) balanced baseline characteristics. The primary outcome was COPD exacerbation; secondary outcomes included acute respiratory failure, pneumonia, and bronchitis over 365 days. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards models.Results Propensity score matching identified 3078 dupilumab-mepolizumab pairs and 2109 dupilumab-benralizumab pairs. Compared with mepolizumab, dupilumab was associated with a numerically lower risk of COPD exacerbation (HR, 0.76; 95% CI, 0.57-1.01) and a significantly lower risk of bronchitis (HR, 0.69; 95% CI, 0.49-0.98). No significant differences were observed between dupilumab and benralizumab for COPD exacerbation (HR, 0.98; 95% CI, 0.70-1.40), acute respiratory failure, pneumonia, or bronchitis.Conclusion In this large real-world cohort study, no statistically significant difference in COPD exacerbation risk was observed between dupilumab and mepolizumab or between dupilumab and benralizumab. However, blood eosinophil counts and baseline lung function measurements were not available in the dataset, so residual confounding cannot be excluded.
SN - 1177-8881
ER -