This real-world study aimed to evaluate medication adherence and treatment persistence in chronic obstructive pulmonary disease (COPD) patients receiving dupilumab, and to identify key determinants influencing long-term treatment continuation.

A retrospective analysis was conducted using clinical records of COPD patients. Participants were stratified into adherent and non-adherent groups based on medication regularity. Clinical improvement was measured by the COPD Assessment Test (CAT), with a reduction ≥2 points defined as meaningful benefit. Multivariable logistic regression (illustrated via forest plot) was applied to identify independent predictors of adherence. Kaplan-Meier survival analysis was performed to compare treatment persistence across different response subgroups.

Baseline demographic and lung function characteristics were comparable between groups, with no statistically significant differences in age, sex, or baseline pulmonary function (all P>0.05). Follow-up data indicated that higher adherence was associated with greater symptomatic relief, evidenced by larger reductions in CAT scores, and adherence status positively correlated with CAT improvement (P=0.003). After adjusting for confounders in logistic regression, CAT improvement (≥2 points) remained the only independent protective factor for high adherence (OR=0.28, 95%CI: 0.10~0.72, P=0.011). Kaplan-Meier curves further revealed significantly longer treatment persistence in the clinically improved group compared to the non-improved group (Log-rank P=0.0012). The median treatment duration was only 28 days in the non-improved group, whereas the improved group demonstrated stronger willingness to continue treatment, with markedly prolonged persistence.

In the real-world self-pay healthcare setting, continued use of dupilumab in COPD patients largely depends on early perceived symptomatic benefit. Early improvement in CAT score serves as a critical predictor for treatment persistence. Clinical practice should emphasize close monitoring of initial treatment response and proactive communication with patients regarding efficacy and cost-effectiveness, in order to tailor individualized therapy and avoid prolonged low-benefit treatment.