Dupilumab treatment for severe chronic rhinosinusitis with nasal polyps: efficacy and impact on co-existing mild to moderate asthma

Aim: This study aims at assessing dupilumab’s response in severe chronic rhinosinusitis with nasal polyps (CRSwNP) and its impact on concurrent mild to moderate asthma. Methods: The study involved severe, uncontrolled CRSwNP patients starting dupilumab treatment (300 mg/2 weeks) at the Allergy unit in University General Hospital “Attikon” in Athens, Greece, from May 2020 to July 2022. Assessments were conducted at baseline (week 0) and weeks 2, 4, 16, 24, and 52, covering 22-item Sino-Nasal Outcome Test (SNOT22), blood eosinophil counts, fractional exhaled nitric oxide (FeNO) concentration, Lund-Mackay CT scores (weeks 0, 16, and 52), Asthma Control Test (ACT) scores (weeks 0, 16, and 52), and forced expiratory volume in one second (FEV1) measurements (weeks 0, 16, and 52). Systemic corticosteroid usage, nasal surgeries, and anosmia improvements were also monitored throughout the study. Results: Six patients (50% male, mean age 53.1 years) with severe CRSwNP had severe uncontrolled baseline symptoms: complete anosmia, impaired quality of life (mean SNOT22: 71.6 ± 16.2), and Lund-Mackay CT score of 19.3 ± 2. Within the past year, 83.3% received over three courses of systemic corticosteroids for CRSwNP, and 50% had more than three polypectomies. After two weeks of dupilumab treatment, notable improvements were seen: reduced SNOT22 scores (week 2: 32.5, week 4: 18.1, week 16: 14, week 24: 13.8, week 52: 9.3), improved olfaction (weeks 4–16), reduced polyp size based on Lund-Mackay CT score (week 16: 13.3, week 52: 12.8), and enhanced lung function (FEV1 baseline: 3.15 L, week 16: 3.22 L, week 52: 3.22 L). Control was achieved by week 16 (ACT: 25/25). FeNO levels decreased week 2: (18.2 ± 8.7) ppb, week 4: (16.5 ± 7.4) ppb, week 16: (16.9 ± 7.8) ppb, week 24: (13.7 ± 8.3) ppb, week 52: (13.4 ± 5.6) ppb. No patients required nasal surgery. Conclusions: Dupilumab effectively targets interleukin 4 (IL4) and IL13, controlling type 2 inflammation spectrum, thus providing significant disease control for CRSwNP patients. Moreover, it improves asthma, even in mild to moderate cases, showcasing its broader therapeutic benefits.