Dual response to Dupilumab in patients with severe asthma and nasal polyposis

Dupilumab is a selective monoclonal antibody targeting the alpha subunit of the interleukin-4 receptor, blocking the T2 signaling pathways. Clinical efficacy has been assessed in Phase III studies, and approved indications include severe refractory asthma with elevated T2 markers and severe refractory nasal polyposis. The objective of this study was to assess the dual effectiveness of Dupilumab in a cohort of patients with uncontrolled severe asthma and concomitant nasal polyposis. This is a prospective observational single-center study, with patients who initiated Dupilumab between April 2022 and July 2023. Asthma response variables included the Asthma Control Test (ACT) score, oral corticosteroids dose, annual exacerbations and pre-bronchodilator FEV1. For nasal polyposis, it included the 22-item Sino-Nasal Outcome Test (SNOT-22), an olfactometry test using the sniffin' sticks method (TDIT), visual analog scale (VAS) for overall nasal symptoms, and the Nasal Polyp Score (NPS) evaluated with nasal endoscopy. 20 patients were included with a median age of 59.5 years [IQR: 47-66], 45% women. The distribution of demographic and clinical variables is presented in Table 1. Most patients had previously undergone nasal polyposis surgery, and 55% had received prior biological therapy. Figure 1 shows a clinically significant improvement in ACT, respiratory function and in the number of exacerbations. A significant reduction in the mean dose of oral glucocorticoids could not be demonstrated. Patients treated with dupilumab also improved in SNOT-22, TDIT, VAS and NPS. In conclusion, Dupilumab therapy in our real-life cohort of patients with asthma and polyposis is effective in a dual manner.