Dupilumab for the treatment of chronic rhinosinusitis with nasal polyposis

Abstract

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) affects 1-2.5% of the population and is associated with significant adverse effects on quality of life (QoL). CRSwNP is strongly correlated with (late onset) asthma with 30-70% of the CRSwNP patients having asthma. Health-care spending in rhinosinusitis is high, especially because of indirect costs. Areas covered: In the last years, the recognition of endotyping as an essential presumption to precision medicine has significantly changed the integrated care pathways in the treatment of chronic rhinosinusitis. Dupilumab is the first biological available for the treatment of CRswNP, since late 2019. Treatment with dupilumab results in a significant improvement of QoL (measured as SNOT-22), rhinosinusitis disease severity, symptoms of rhinosinusitis, and especially sense of smell, nasal polyp score, Lund-Mackay CT score, and asthma outcomes (ACQ5 and FEV1) compared to placebo. Expert opinion: At this moment, the high cost of the treatment requires careful patient selection and within the EUFOREA and EPOS2020 context, experts have tried to give guidance based on today's data. We now need trials evaluating which patients benefit most from treatment with biologicals and in which patients the treatment is cost-effective.

Chinese Expert Consensus on the Use of Biologics in Patients with Chronic Rhinosinusitis (2022, Zhuhai)

“…Among the CRSwNP population with adverse effects to dupilumab, women and the elderly are at higher risk of developing adverse events, while male patients are more likely to have severe adverse events [43]. In addition to injection site reaction, nasopharyngitis, headaches, epistaxis, hypereosinophilia, ophthalmic complications, head and neck dermatitis, alopecia areata, and arthritis are occasionally seen during the use of dupilumab [44, 45].…”

Delayed Hyperpigmented Injection Site Reactions Due to Chronic Dupilumab Use

“…In patients with aspirin-exacerbated respiratory disease (AERD), nasal polyposis can be particularly severe and difficult to control with both pharmacologic and operative interventions [1]. Dupilumab is a monoclonal antibody that inhibits interleukin 4 (IL-4) receptor alpha and is highly effective in reducing nasal polyp burden, preventing recurrent sinus surgery, and reducing sinus infections in patients with severe CRSwNP, particularly those with AERD [2][3][4]. The most common adverse reactions from dupilumab use include temporary injection site reactions, ocular surface reactions, and transient eosinophilia [5].…”

Computational fluid dynamic modeling of the effect of dupilumab in the management of anosmia secondary to chronic rhinosinusitis with nasal polyps (CRSwNP)

“…Previous studies have implicated the role of interleukin 13 (IL-13) in inducing damage to olfactory epithelium, suggesting a possible sensorineural anti-inflammatory mechanism. [3][4][5] Studies have also shown a significant reduction in polyp burden after dupilumab, suggesting there may be a conductive component, although this mechanism has not been quantitatively confirmed. 5 The goal of this study is to use computational fluid dynamic modeling (CFD) to examine the potential conductive mechanism of how dupilumab may alleviate olfactory loss in patients with CRSwNP.…”