Effectiveness of dupilumab treatment against refractory eosinophilic chronic rhinosinusitis

• DOI: 10.1016/j.jacig.2025.100412
• Publication Date: 2025-01-18T19:51:00Z
• Authors: Daiki Nakashima; Tsuguhisa Nakayama; Shunsuke Minagawa; Tetsuya Adachi; Chieko Mitsuyama; Yoko Shida; Tsuneya Nakajima; Shin-ichi Haruna; Yoshinori Matsuwaki
• Keywords: meta-analysis; corticosteroid; Eosinophilic chronic rhinosinusitis; dupilumab; Immunologic diseases. Allergy; RC581-607

Background: Eosinophilic chronic rhinosinusitis (ECRS) is a subgroup of chronic rhinosinusitis with nasal polyps (CRSwNP), which is a disease characterized by eosinophilic infiltration of the sinonasal mucosa. Few studies that reported the effect of dupilumab on CRSwNP focused on a single phenotype of CRSwNP, such as ECRS. Objectives: This study aimed to determine the effectiveness of dupilumab in ECRS with postoperative recurrence. Methods: We retrospectively enrolled 107 patients and assessed the effectiveness of dupilumab by various clinical outcomes. We performed multivariable analysis on nasal polyp score (NPS) and computed tomography score and a meta-analysis of the effect of dupilumab on chronic rhinosinusitis regarding improvement in the NPS. Results: At 12 months of dupilumab treatment, there were 65 patients (60.7%) in the excellent response group and 42 (39.3%) in the moderate response group. Nasal polyps had disappeared in 91 patients (85.9%) at 12 months, and there was improvement in all end points; 104 patients (97.2%) were able to eliminate systemic corticosteroid therapy. In the multivariate analysis, male sex was significantly associated with patients who did not show an improvement to 0 in the NPS and computed tomography score (odds ratios: 7.58 and 2.45; P = .01 and P = .04, respectively). The meta-analysis showed that dupilumab treatment resulted in a trend toward better improvement in the NPS (mean difference = −5.41) than previously reported results. Conclusions: Dupilumab shows effectiveness in treating ECRS and could serve as an alternative therapeutic option to systemic corticosteroids. This effectiveness may be further enhanced by limiting the target population to recurrent ECRS.