Effects of dupilumab on nasal mucociliary clearance in severe CRSwNP: evaluation of the saccharin test as an objective outcome measure

Abstract Objective Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic, relapsing condition associated with a significant impairment in quality of life. Persistent inflammation contributes to dysfunction of mucociliary clearance. Dupilumab (IL-4Rα inhibitor) is a well-established therapeutic agent that has demonstrated significant efficacy in reducing type 2 inflammation and improving quality of life in patients with severe CRSwNP refractory to medical and/or surgical treatment. This study aimed to evaluate whether dupilumab therapy improves mucociliary clearance in patients with CRSwNP. Methods Twenty-one patients with severe CRSwNP were enrolled. All received dupilumab (300 mg subcutaneously every 2 weeks) according to prescribing criteria. At baseline and after 4, 8, and 12 weeks, patients underwent evaluation with SNOT-22, nasal endoscopy with Nasal Polyp Score (NPS), and assessment of mucociliary clearance using the saccharin test (ST). Nasal mucociliary clearance time (NMCT) values were compared across time points.. Results Significant improvements were observed in SNOT-22, NPS, and NMCT. Mean NMCT values measured using the ST values decreased from 14.3 minutes at baseline to 10.1 minutes at 4 weeks (p<.01), 7.75 minutes at 8 weeks, and 5.84 minutes at 12 weeks, indicating a progressive and statistically significant enhancement of mucociliary clearance. Conclusions Short-term dupilumab therapy was associated with a significant improvement in nasal mucociliary clearance in patients with severe CRSwNP. These preliminary findings support the potential role of the saccharin test as a simple, objective tool for monitoring response to biologic therapy.