Effect of Dupilumab on Radiological Remission in Patients with Chronic Rhinosinusitis with Nasal Polyp: A One Step Forward Toward Clinical Remission

Mona Al-Ahmad,1,2,&ast; Asmaa Ali,2– 4,&ast; Haitham A Dawood,5 Gerges M Beshreda6 1Department of Microbiology, College of Medicine, Kuwait University, Kuwait City, Kuwait; 2Department of Allergy, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait; 3Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, People’s Republic of China; 4Department of Pulmonary Medicine, Abbassia Chest Hospital, Ministry of Health, Cairo, Egypt; 5Department of Diagnostic Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt; 6Department of Diagnostic Radiology, Faculty of Medicine, Minia University, Minia, Egypt&ast;These authors contributed equally to this workCorrespondence: Mona Al-Ahmad, Microbiology Department, College of Medicine, Kuwait University, P.O. Box 24923, Safat, Kuwait City, 13110, Kuwait, Tel +965-24636515, Fax +965-25332719, Email [email protected] and Objectives: While achieving complete radiological improvement in patients with nasal polyps is often observed following surgical resection, the impact of biologic therapy, specifically dupilumab, on polyp size is an area of great interest. The objective of this study was to assess the effect of dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) by assessing nasal polyps using the computed tomography (CT) staging system, Lund–Mackay score (LMS).Methods: A two-year prospective cohort study was conducted on 29 patients diagnosed with CRSwNP and asthma and eligible for dupilumab as an add-on therapy. The study involved comprehensive assessments of patients before biologic initiation and after the study. These assessments included clinical, laboratory, and radiological evaluations.Results: Dupilumab treatment reduces LMS across sinuses (p< 0.001) and improves nasal obstruction (p=0.001). Blood eosinophil count (BEC) predicts persistent sinus obstruction, doubling the likelihood per unit increase (odds ratio: 1.67, p=0.02). BEC levels identify persistent nasal obstruction (AUC: 76%, p=0.04), with a cutoff point above 255.5 cells per microliter, revealing a sensitivity of 100% and a specificity of 42%. The probability of persistent nasal obstruction at the 20th month is 55%, regardless of prior nasal polyp surgery (p=0.41).Conclusion: Dupilumab led to significant radiological improvements in patients with CRSwNP, demonstrating a potential role of radiological remission, irrespective of prior nasal polyp surgery. Additionally, BEC levels may guide the likelihood of persistent nasal obstruction.Keywords: chronic rhinosinusitis with nasal polyps, dupilumab, radiological remission, Lund–Mackay score