Dupilumab for refractory chronic rhinosinusitis in eosinophilic granulomatosis with polyangiitis

Roberto Padoan; Federica Davanzo; Luca Iorio; Tommaso Saccardo; Giuseppe Roccuzzo; Sonny Zampollo; Piero Nicolai; Andrea Doria; Giancarlo Ottaviano

doi:10.1093/rheumatology/keae554

Dupilumab for refractory chronic rhinosinusitis in eosinophilic granulomatosis with polyangiitis

Rheumatology (Oxford). 2024 Oct 16:keae554. doi: 10.1093/rheumatology/keae554. Online ahead of print.

Authors

Roberto Padoan¹, Federica Davanzo¹, Luca Iorio¹, Tommaso Saccardo², Giuseppe Roccuzzo², Sonny Zampollo², Piero Nicolai², Andrea Doria¹, Giancarlo Ottaviano²

Affiliations

¹ Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy.
² Otolaryngology Section, Department of Neurosciences DNS, University of Padua, Padua, Italy.

PMID: 39412652
DOI: 10.1093/rheumatology/keae554

Abstract

Objectives: Eosinophilic granulomatosis with polyangiitis (EGPA) is frequently associated with refractory chronic rhinosinusitis with nasal polyps (CRSwNP), despite current treatments. Dupilumab demonstrated efficacy in the treatment of severe and uncontrolled CRSwNP, with improvements in patient-reported outcome measures and in objective measurements. This study aims to evaluate efficacy and safety of dupilumab in refractory CRSwNP in EGPA patients.

Methods: A prospective observational study was conducted on EGPA patients treated with dupilumab between 2021 and 2023. Patients in a phase of prolonged remission of vasculitis manifestations but still experiencing active CRSwNP were included. Clinical, biological, and rhinologic evaluations were performed, alongside with patient-reported outcomes measures (PROMs) and nasal cytology. Complete response was defined by Birmingham Vasculitis Activity Score (BVAS)=0 and prednisone dose ≤ 4 mg/day, while partial response by BVAS = 0 and prednisone dose >4 mg/day.

Results: Nine EGPA patients were included. After 3 months, 55.6% achieved complete response, increasing to 83.3% at 12 months. Nasal symptoms and patient-reported outcomes improved significantly, with sustained efficacy over 12 months. An improvement in quality of life was also observed, with a significant reduction of the AAV-PRO score. Nasal cytology revealed reductions in eosinophils and neutrophils counts. Adverse events occurred in 44.4%, including hypereosinophilia in 2 cases, which led to dupilumab discontinuation.

Conclusions: Dupilumab is an effective treatment option for severe and refractory ENT manifestations in EGPA, as it improves symptoms, reduces inflammation, and leads to better a quality of life. However, careful patient selection and monitoring are necessary to minimize adverse events and optimize outcomes.

Keywords: chronic asthma; chronic rhinosinusitis; dupilumab; eosinophilic granulomatosis with polyangiitis; vasculitis.