Efficacy of dupilumab for severe chronic rhinosinusitis with nasal polyps and asthma

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology Pub Date : 2024-11-01 DOI:10.1016/j.anai.2024.07.001

{"title":"Efficacy of dupilumab for severe chronic rhinosinusitis with nasal polyps and asthma","authors":"","doi":"10.1016/j.anai.2024.07.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Dupilumab exerts clinical effects, including improved sinus opacification, olfactory function, and quality of life, in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNPs). Meanwhile, only a few studies have reported its effects on nasal airway resistance and olfactory function, particularly in the Japanese population. Predictors of response remain unclear.</div></div><div><h3>Objective</h3><div>To assess the comprehensive efficacy and therapeutic response to dupilumab in patients with severe CRSwNP with comorbid asthma.</div></div><div><h3>Methods</h3><div>In 16 adult patients with severe CRSwNP with comorbid asthma, the efficacy of 48-week dupilumab treatment, including olfactory function measured by a T&T olfactometer, nasal airway resistance measured by rhinomanometry, nasal polyp score, Lund-Mackay computed tomography score, and 22-item Sinonasal Outcome Test (SNOT-22), was assessed. Regarding asthma, the annualized rate of exacerbations, 7-item Asthma Control Questionnaire (ACQ-7), and spirometry were assessed. Treatment responsiveness was analyzed.</div></div><div><h3>Results</h3><div>With 48-week dupilumab treatment, olfactory function, nasal airway resistance, nasal polyp score, Lund-Mackay computed tomography score, and SNOT-22 scores improved significantly. Regarding comorbid asthma, the annualized rate of exacerbations decreased, and ACQ-7 scores and lung function improved significantly. According to the European Position Paper on Rhinosinusitis and Nasal Polyps 2020/European Forum for Research and Education in Allergy and Airway Diseases criteria, 15 patients (94%) were moderate-to-excellent responders at 48 weeks of treatment. Patients with higher SNOT-22 scores, ACQ-7 scores, the rate of asthma exacerbations in the previous year, and blood eosinophil counts benefited more from the treatment.</div></div><div><h3>Conclusion</h3><div>Dupilumab improved upper and lower airway outcomes especially in patients with severe CRSwNP with comorbid, poorly controlled asthma.</div></div><div><h3>Trial Registration</h3><div>UMIN Clinical Trials Registry: UMIN000038669.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"133 5","pages":"Pages 550-558.e2"},"PeriodicalIF":5.8000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Allergy Asthma & Immunology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1081120624004228","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ALLERGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Dupilumab exerts clinical effects, including improved sinus opacification, olfactory function, and quality of life, in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNPs). Meanwhile, only a few studies have reported its effects on nasal airway resistance and olfactory function, particularly in the Japanese population. Predictors of response remain unclear.

Objective

To assess the comprehensive efficacy and therapeutic response to dupilumab in patients with severe CRSwNP with comorbid asthma.

Methods

In 16 adult patients with severe CRSwNP with comorbid asthma, the efficacy of 48-week dupilumab treatment, including olfactory function measured by a T&T olfactometer, nasal airway resistance measured by rhinomanometry, nasal polyp score, Lund-Mackay computed tomography score, and 22-item Sinonasal Outcome Test (SNOT-22), was assessed. Regarding asthma, the annualized rate of exacerbations, 7-item Asthma Control Questionnaire (ACQ-7), and spirometry were assessed. Treatment responsiveness was analyzed.

Results

With 48-week dupilumab treatment, olfactory function, nasal airway resistance, nasal polyp score, Lund-Mackay computed tomography score, and SNOT-22 scores improved significantly. Regarding comorbid asthma, the annualized rate of exacerbations decreased, and ACQ-7 scores and lung function improved significantly. According to the European Position Paper on Rhinosinusitis and Nasal Polyps 2020/European Forum for Research and Education in Allergy and Airway Diseases criteria, 15 patients (94%) were moderate-to-excellent responders at 48 weeks of treatment. Patients with higher SNOT-22 scores, ACQ-7 scores, the rate of asthma exacerbations in the previous year, and blood eosinophil counts benefited more from the treatment.

Conclusion

Dupilumab improved upper and lower airway outcomes especially in patients with severe CRSwNP with comorbid, poorly controlled asthma.

Trial Registration

UMIN Clinical Trials Registry: UMIN000038669.

查看原文本刊更多论文

杜必鲁单抗治疗严重慢性鼻窦炎伴鼻息肉和哮喘的疗效：前瞻性研究。

研究背景杜比鲁单抗对严重慢性鼻窦炎伴鼻息肉（CRSwNP）患者具有临床疗效，包括改善鼻窦不通畅、嗅觉功能和生活质量。与此同时，只有少数研究报告了它对鼻腔气道阻力和嗅觉功能的影响，尤其是在日本人群中。目前尚不清楚反应的预测因素：在这项前瞻性观察研究中，我们评估了合并哮喘的重度 CRSwNP 患者对杜必鲁单抗的综合疗效和治疗反应：在 16 名合并哮喘的成年重度 CRSwNP 患者中，我们评估了为期 48 周的杜比鲁单抗治疗的疗效，包括用 T&T 嗅觉仪测量的嗅觉功能、用鼻量计测量的鼻气道阻力、鼻息肉评分、Lund-Mackay 计算机断层扫描评分（LMS）和 22 项鼻窦结果测试（SNOT-22）。在哮喘方面，对哮喘的年加重率、7 项哮喘控制问卷（ACQ-7）和肺活量进行了评估。对治疗反应性进行了分析：结果：经过48周的dupilumab治疗，嗅觉功能、鼻气道阻力、鼻息肉评分、LMS和SNOT-22评分均有显著改善。在合并哮喘方面，病情加重率下降，ACQ-7评分和肺功能明显改善。根据《2022 年欧洲鼻炎和鼻息肉立场文件》/欧洲过敏和气道疾病研究与教育论坛的标准，15 名患者（94%）在治疗 48 周后达到中度到极佳反应。SNOT-22评分、ACQ-7评分、前一年哮喘加重率和血液嗜酸性粒细胞计数较高的患者从治疗中获益更多：结论：杜匹单抗可改善上呼吸道和下呼吸道的治疗效果，尤其是对合并哮喘且治疗效果不佳的重症CRSwNP患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Annals of Allergy Asthma & Immunology 医学-过敏

CiteScore

6.50

自引率

6.80%

发文量

437

审稿时长

33 days

期刊介绍： Annals of Allergy, Asthma & Immunology is a scholarly medical journal published monthly by the American College of Allergy, Asthma & Immunology. The purpose of Annals is to serve as an objective evidence-based forum for the allergy/immunology specialist to keep up to date on current clinical science (both research and practice-based) in the fields of allergy, asthma, and immunology. The emphasis of the journal will be to provide clinical and research information that is readily applicable to both the clinician and the researcher. Each issue of the Annals shall also provide opportunities to participate in accredited continuing medical education activities to enhance overall clinical proficiency.