Dupilumab in the treatment of severe chronic rhinosinusitis with nasal polyps (CRSwNP) in cystic fibrosis patients.

Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) manifests as either a solitary upper airway involvement or as part of a more intricate clinical picture, such as Cystic Fibrosis (CF). The altered viscoelastic properties of mucus facilitate the colonisation of bacteria, thereby instigating a process that perpetuates a state of chronic inflammation. Dupilumab, a monoclonal antibody that blocks IL-4/IL-13-signalling, has been demonstrated to improve nasal obstruction and the sense of smell. This observational real-life study comprised 10 patients diagnosed with CRSwNP and CF. The following scores were considered to ascertain the severity of rhinosinusitis: Nasal Polyp Score (NPS), Sino-Nasal Outcome Test (SNOT-22 score), Nasal Congestion/Obstruction Symptom severity score (NCS), Visual Analogue Scale for rhinosinusitis (VAS), and Loss of Smell score (LOS). Moreover, spirometry parameters and the number of new infections/hospital admissions were considered for lung involvement. Blood parameters, including the number of eosinophils and the total serum IgE level, were assessed. After six months of therapy, the median value of the NPS score decreased from 4 (IQR 1.75) to 1.5 (IQR 4.5; P < 0.01) and the SNOT-22 score from 55 (IQR 8.75) to 13.5 (IQR 13.5; P < 0.0001). FEV1 improved from a median value of 2.28 L (IQR 1.26) to 2.54 L (IQR 1.02). Serum IgE and blood eosinophil count did not change significantly. Dupilumab has proven to be effective in reducing the size of nasal polyps and improving associated symptoms in patients with CF who have type 2inflammation-related comorbidities, without the occurrence of adverse events.