Dupilumab improves clinical outcomes in patients having chronic rhinosinusitis with nasal polyps

Anju T Peters, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and colleagues found that dupilumab showed significant improvements in both clinical endpoints and symptom scores versus placebo in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP). The improvement was seen regardless of comorbid AR status, a common subgroup of patients often associated with poorer CRSwNP outcomes.

Dupilumab is a fully human monoclonal antibody which blocks the shared receptor component for interleukin-4 and interleukin-13, key and central drivers of type 2 inflammation.

Chronic rhinosinusitis with nasal polyps is a predominant type 2 inflammatory disease, which often coexists with allergic rhinitis. Anju T Peters, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and colleagues aimed to investigate the safety and efficacy of dupilumab in patients with severe CRSwNP with or without coexisting AR in the pooled phase III SINUS-24/SINUS-52 studies.

In this, post-hoc analysis, the researchers analyzed patients randomized to subcutaneous dupilumab 300 mg (n = 438) or placebo (n = 286) every 2 weeks for 24 (SINUS-24) or 52 weeks (SINUS-52). They presented pooled data from the first 24 weeks of treatment. Patient-reported history of AR status was used to analyze the change from baseline in biomarker levels and disease outcome measures.

The researchers reported the following findings:

• 338 of 724 patients had allergic rhinitis. Baseline characteristics were generally similar between patients with and those without AR.
• Dupilumab significantly improved objective and patient-reported measures of CRSwNP, including loss of smell, and reduced systemic and nasal biomarker levels versus placebo at week 24, with no significant treatment difference between patients with and those without AR.
• Use of systemic corticosteroids and/or sinonasal surgery during treatment was significantly reduced with dupilumab versus placebo, irrespective of AR status.
• The safety profile of dupilumab was similar in patients with and in patients without AR.

"We observed significant improvements in h clinical endpoints and symptom scores with Dupilumab treatment versus placebo in patients with severe CRSwNP," the researchers wrote. "The improvements were seen irrespective of comorbid AR status, a common subgroup of patients often associated with poorer CRSwNP."

Reference:

Peters AT, Wagenmann M, Bernstein JA, Khan AH, Nash S, Jacob-Nara JA, Siddiqui S, Rowe PJ, Deniz Y. Dupilumab efficacy in patients with chronic rhinosinusitis with nasal polyps with and without allergic rhinitis. Allergy Asthma Proc. 2023 Jul 1;44(4):265-274. doi: 10.2500/aap.2023.44.230015. PMID: 37480206.