Dissociated Biologic Responses Across the United Airway: A Case Report of Severe Asthma With Chronic Rhinosinusitis With Nasal Polyps and Eosinophilic Otitis Media.

Abstract

Asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), and eosinophilic otitis media (EOM) share type 2 inflammatory pathways. Although type 2-targeted biologic therapies have shown efficacy for these diseases, some patients exhibit dissociated responses to a single biologic. A case of severe asthma with CRSwNP and EOM that showed dissociated responses to biologic therapies and was successfully managed by biologic switching is reported. A 55-year-old man with asthma, recurrent CRSwNP requiring multiple surgeries and oral corticosteroid-dependent EOM was referred to our hospital. Nineteen months after starting dupilumab, EOM and endoscopic and radiological findings of CRSwNP improved partially. However, his nasal symptoms and olfactory dysfunction persisted, and asthma remained uncontrolled. After switching from dupilumab to mepolizumab, asthma control, nasal symptoms and olfactory dysfunction improved, and EOM remained well controlled. Careful monitoring of disease activity and consideration of biologic switching may help achieve optimal control in patients with type 2 united airway diseases.