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Dupilumab improves symptoms and reduces rescue treatments in patients with CRSwNP and recalcitrant frontal sinusitis
  • +10
  • Eugenio De Corso,
  • Stefano Settimi,
  • Daniele Penazzi,
  • Giuseppe D'Agostino,
  • Claudio Montuori,
  • Marco Corbò,
  • Camilla Spanu,
  • Alberta Rizzzuti ,
  • Maria Clara Pacilli,
  • Mario Rigante,
  • Angela Rizzi,
  • Raffaella Chini,
  • Jacopo Galli
Eugenio De Corso
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
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Stefano Settimi
Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Corresponding Author:[email protected]

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Daniele Penazzi
Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia
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Giuseppe D'Agostino
Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia
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Claudio Montuori
Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia
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Marco Corbò
Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia
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Camilla Spanu
Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia
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Alberta Rizzzuti
Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia
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Maria Clara Pacilli
Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia
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Mario Rigante
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
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Angela Rizzi
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
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Raffaella Chini
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
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Jacopo Galli
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
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Abstract

Background. Recalcitrant frontal sinusitis in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have a negative impact on quality of life due to frontal pain and a high risk of sinus occlusion, thus necessitating repeated courses of antibiotics, systemic corticosteroids, and multiple surgeries. Objective. The aim of this study was to investigate if the use of biologics can improve symptoms including facial pain and reduce use of rescue treatments in patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis. Materials and Methods. This is a real-life, observational, no-profit case series. Between November 2022 and December 2023, we enrolled cohort of 10 patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis associated to invalidating facial pain measured by MIDAS score and that were treated with dupilumab 300 mg every 2 week and followed for at least 12 months. Results. the mean MIDAS score decreased from 45.6±10.7 at baseline to 1.3±2.3 at 6 months (p<0.05). The same trend was observed for VAS craniofacial pain: from 7.3±1.6 at baseline to 1.2±1.5 at 6 months (p<0.05). The use of systemic corticosteroids and analgesics was significantly reduced. No patient needed oral corticosteroids during treatment with dupilumab (p<0.05), and the use of analgesics decreased from 9.6±3.1 mean brief cycles of NSAIDs at baseline to 0.6±1.3 at 1 year of follow-up (p<0.05). Discussion. Our results demonstrated that use of an anti-type-2 inflammatory pathway biologic can improve symptom control including recurrent craniofacial pain and reduce the need for rescue medical treatments in patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis.