Dupilumab Leads to Favorable Outcomes for Chronic Rhinosinusitis

Michael B. Soyka, MD

New research suggests dupilumab is an optimal treatment for patients with chronic rhinosinusitis with a type 2 inflammation pattern (T2CRS).

A team, led by Michael B. Soyka, Department of Otorhinolaryngology, Head and Neck Surgery University and University Hospital Zurich, identified clinical and serological markers associated with a treatment response to dupilumab in patients with chronic rhinosinusitis with a type 2 inflammatory pattern.

The Disease

Chronic rhinosinusitis with a type 2 inflammation pattern is considered to be restricted to the nose and sinuses. The condition is also associated with polyps, without clear serologic markers.

One potential treatment option for patients with difficult to treat chronic rhinosinusitis with a type 2 inflammatory pattern is dupilumab. However, there are no factors known to predict dupilumab treatment outcome.

In the study, the investigators examined patients treated with dupilumab. Each patient was assessed clinically to report ultra-short and short-term outcomes for up to 90 days. The investigators collected serum samples at day 0 and 30 days of treatment and performed proteomic analyses using Olink.

Comparing Results

They then compared the results to a healthy control group and confirmed the predictive parameters in a prospective cohort of 20 patients with chronic rhinosinusitis with a type 2 inflammatory pattern.

The study included 30 total patients, 80% of which were treatment responders. The investigators found SinoNasalOutcomeTest-20 (SNOT-20) scores and the total nasal polyp scores improved significantly on day 7 (P <0.05). There also was an improvement of 2,5 points at the first visit linked to a favorable outcome with a sensitivity of 86%.

They also found significant changes compared to the healthy control group using the proteomic analyses.

Finally, the investigators identified Osteoprotegerin (OPG) in the serum of dupilumab treated patients, which could act as a predictor for clinical outcomes of dupilumab treatment. The predictive value of OPG was confirmed in a second cohort.

“Clinical response after one week of treatment with dupilumab is highly associated with a favorable outcome. High sensitivity proteomic analyses can identify T2CRS specific dysregulated proteins in serum,” the authors wrote. “Serum OPG may serve as a predictor for dupilumab treatment outcome before the initiation of any therapy.”

Dupilumab

Earlier this year, investigators found chronic rhinosinusitis was a comorbidity for patients with asthma and bronchiectasis.

Investigators led by Margaret S. Kim, MD, Allergy and Immunology at Northwestern Medicine, Chicago, reviewed electronic medical records of patients with asthma and comorbid chronic rhinosinusitis and/or bronchiectasis between 1988 and 2021.

Of a total of 5038 patients with asthma who had a chest CT were identified, 19% had bronchiectasis, 39% had chronic rhinosinusitis, and 9.8% had both.

Patients with asthma and bronchiectasis were more likely to have chronic rhinosinusitis than patients without bronchiectasis (51% and 36%, respectively).

Additionally, asthmatics with both conditions had a higher odds rates of oral corticosteroids use of 2.3, as well as a 3.0 higher odd of antibiotics use, and a 1.6 higher odd of hospitalization or emergency department visit.

The study, “Predicting Dupilumab Treatment Outcome in Patients with Primary diffuse Type 2 Chronic Rhinosinusitis,” was published online in Allergy.