CASE REPORT: SUCCESSFUL REINTRODUCTION OF IBUPROFEN IN A PATIENT WITH NERD FOLLOWING TREATMENT WITH DUPILUMAB

Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD) is characterized by asthma, nasal polyposis, and NSAID intolerance. Dupilumab has been shown to increase aspirin tolerance in 57% of NERD patients after 6 months of therapy. However, data evaluating the tolerance of ibuprofen and other NSAIDS following therapy with dupilumab is lacking. A 57-year-old male with a past medical history of asthma, nasal polyps, and intolerance to multiple NSAIDs, including ibuprofen, aspirin, celecoxib, and acetaminophen, was experiencing significant musculoskeletal (MSK) pain from his manufacturing occupation. To treat his nasal polyps and asthma, dupilumab 300mg every 2 weeks was initiated. Prior to therapy with dupilumab, he had developed hives, angioedema, and wheezing with aspirin 81mg and developed chest tightness and wheezing following just 200mg of ibuprofen. After 18 months on dupilumab and continued MSK pain, he was successfully challenged to 400mg of ibuprofen. He has since been able to tolerate ibuprofen at home, averaging 400mg weekly, leading to reduced MSK pain and improved quality of life. We describe the successful induction of ibuprofen tolerance in a patient with NERD following therapy with dupilumab. Given that aspirin and ibuprofen have similar mechanisms of action, we hypothesized dupilumab could induce tolerance to ibuprofen and other selective and/or non-selective cyclooxygenase inhibitors. While the success of this case shows promising therapeutic potential, further investigation is required to evaluate the reproducibility and efficacy of dupilumab to induce ibuprofen tolerance on a larger scale.