Clinical efficacy of dupilumab monoclonal antibody in the treatment of recurrent severe chronic rhinosinusitis with nasal polyps without bronchial asthma

Dupilumab is a monoclonal antibody effectively used in the therapy of recurrent chronic rhinosinusitis with nasal polyps (CRSwNP), particularly in cases resistant to conventional treatment methods. The mechanism of action of dupilumab is aimed at blocking interleukin-4 (IL-4) and interleukin-13 (IL-13), which leads to a reduction in the inflammatory response and size of nasal polyps. Objective. To evaluate the efficacy of dupilumab monoclonal antibody use in the treatment of severe recurrent CRSwNP without bronchial asthma. Patients and methods. A total of 52 patients with severe CRSwNP without concomitant bronchial asthma, who previously underwent one or more surgical interventions aimed at removing polyps from the nasal cavity and paranasal sinuses, were included in the study. All patients received a drug containing dupilumab during 6 months in the form of subcutaneous injection (300 mg) 1 time repeated for 14 days. Efficacy of therapy was evaluated on the basis of endoscopic picture (Lund-Kennedy score), computed tomography (Lund-Mackay score), data of SNOT-22, NOSE subjective questionnaires and visual analogue scale dynamics. Results. A regression of the main symptoms of CRSwNP (improvement of olfaction and taste, reduction of sense of pain/pressure in the area of face, cold, post-nasal drip, nasal congestion) has been noted in patients in presence of therapy with dupilumab. The mean value on the SNOT-22 was initially 57.8±8.5 scores, 6 months after the first treatment — 18.9±7.7 scores (p<0.001); on the VAS — 8.5±1.0 and 2.3±0.9 scores, respectively (p<0.001), on the NOSE — 82.5±1.8 and 17.5±1.3 scores; on the LMS — 19.0±2.7 and 4.8±1.4 scores; on the LKS — 9.2±1.3 and 2.7±0.9 scores. The mean total serum IgE level decreased from 150.4±89.2 to 126.3±101.3 IU/mL. Results. Significant efficacy of dupilumab has been demonstrated in the treatment of patients with severe CRSwNP without concomitant bronchial asthma, which is expressed in a significant reduction in the size of polyps of the nasal cavity and paranasal sinuses, improvement of nasal breathing, reduction of CRSwNP symptoms severity as well as improvement of the patients’ quality of life. This molecule has a favorable safety profile, which makes it a promising agent of biological therapy for patients with severe CRSwNP without concomitant bronchial asthma.