Dupilumab improves symptoms and reduces rescue treatments in patients
with CRSwNP and recalcitrant frontal sinusitis
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.