Clinical management of dupilumab-induced blood eosinophilia in CRSwNP: a practical algorithm

Dupilumab is widely recognised as a highly effective therapy for severe chronic rhinosinusitis with nasal polyps (CRSwNP). A rise in blood eosinophil count (BEC) might occur during treatment across all approved indications. In CRSwNP, dupilumab-induced blood eosinophilia (DIBE) is typically of early onset, transient, and asymptomatic without impairing the drug’s efficacy. A review including data from 11 clinical trials on all approved dupilumab indications reported eosinophilia-related clinical manifestations in only 7 of 4,666 patients receiving dupilumab. Real-world studies confirm DIBE is largely benign, with only rare AEs requiring dupilumab discontinuation such as eosinophilic pneumonia, especially in eosinophilic granulomatosis with polyangiitis (EGPA) patients. Such exceedingly rare events were mainly described within the first months of treatment, however late onset DIBE (after 6 months) has also been detected, especially in patients dependent on systemic corticosteroids.