Factors Associated With Dupilumab Efficacy in Patients With Chronic Rhinosinusitis With Nasal Polyps.

Abstract

Objective: Dupilumab is effective in treating patients with intractable chronic rhinosinusitis with nasal polyps (CRSwNP); however, the factors influencing its efficacy remain unclear. Systemic corticosteroids (SCS) are occasionally administered to patients receiving dupilumab; however, concomitant use can obscure the efficacy of dupilumab. The present study aimed to investigate the factors associated with the efficacy of dupilumab, while minimizing the influence of SCS.

Study design: Retrospective longitudinal study.

Setting: A single academic hospital.

Methods: We retrospectively evaluated medical records of 193 patients who started dupilumab for CRSwNP at our institution between March 2020 and July 2023. Patients who were prescribed SCS even once during a specific period were excluded. Finally, 50 patients were enrolled. We assessed correlations between pre-treatment parameters (age, time since last sinus surgery, blood eosinophil count, blood eosinophil proportion, and serum total immunoglobulin E) and endpoints (changes in nasal polyp score, nasal congestion score, and Lund-Mackay computed tomography score [LMK-CTS] from baseline). Additionally, the endpoints were compared between subgroups (male vs female, presence vs absence of asthma, presence vs absence of nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, and three groups classified according to the blood eosinophil proportion).

Results: Statistically, neither significant differences between the subgroups nor significant correlations between the parameters and the endpoints were observed, except for a correlation between the blood eosinophil proportion and the changes in LMK-CTS (r = 0.47, P = .037 [n = 21]).

Conclusion: Although a higher baseline peripheral blood eosinophil percentage may be associated with smaller changes in LMK-CTS, our findings need further investigation.