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De Corso E, Settimi S, Penazzi D, D’Agostino G, Corbò M, Rigante M, Montuori C, Rizzuti A, Pacilli MC, Di Cesare T, Lo Verde S, Rizzi A, Chini R, Galli J. Dupilumab Improves Facial Pain and Reduces Rescue Treatments in Patients with CRSwNP and Recalcitrant Frontal Sinusitis. J Pers Med 2024; 14:735. [PMID: 39063989 PMCID: PMC11277593 DOI: 10.3390/jpm14070735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/30/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Recalcitrant frontal sinusitis in patients with chronic rhinosinusitis and nasal polyps (CRSwNP) has a negative impact on their quality of life due to frontal pain and a high risk of sinus occlusion, thus necessitating antibiotics, systemic corticosteroids, and multiple surgeries. The aim of this study was to assess the efficacy of dupilumab in reducing frontal pain and the need for rescue treatments for recalcitrant frontal sinusitis in patients with CRSwNP. We enrolled a cohort of 10 patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis associated with severe facial pain measured by MIDAS score who were treated with dupilumab 300 mg every 2 weeks and followed for at least 12 months. The mean MIDAS score decreased from 45.6 ± 10.7 at baseline to 1.3 ± 2.3 at 6 months (p < 0.05). VAS craniofacial pain decreased from 7.3 ± 1.6 at baseline to 1.2 ± 1.5 at 6 months (p < 0.05). No patient needed oral corticosteroids during treatment with dupilumab (p < 0.05), and the use of analgesics decreased from 9.6 ± 3.1 NSAID pills/week in the last 2 months at baseline to 0.6 ± 1.3 at 1 year of follow-up (p < 0.05). Our results demonstrated that use of subcutaneous dupilumab can improve symptom control, including recurrent severe cranio-facial pain, and reduce the need for rescue medical treatments (systemic steroids and NSAID) in patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology and Head-Neck Surgery, “A. Gemelli” University Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (M.R.); (T.D.C.); (J.G.)
| | - Stefano Settimi
- Unit of Otorhinolaryngology and Head-Neck Surgery, “A. Gemelli” University Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (M.R.); (T.D.C.); (J.G.)
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168 Rome, Italy; (D.P.); (G.D.); (M.C.); (C.M.); (A.R.); (M.C.P.); (S.L.V.)
| | - Daniele Penazzi
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168 Rome, Italy; (D.P.); (G.D.); (M.C.); (C.M.); (A.R.); (M.C.P.); (S.L.V.)
| | - Giuseppe D’Agostino
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168 Rome, Italy; (D.P.); (G.D.); (M.C.); (C.M.); (A.R.); (M.C.P.); (S.L.V.)
| | - Marco Corbò
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168 Rome, Italy; (D.P.); (G.D.); (M.C.); (C.M.); (A.R.); (M.C.P.); (S.L.V.)
| | - Mario Rigante
- Unit of Otorhinolaryngology and Head-Neck Surgery, “A. Gemelli” University Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (M.R.); (T.D.C.); (J.G.)
| | - Claudio Montuori
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168 Rome, Italy; (D.P.); (G.D.); (M.C.); (C.M.); (A.R.); (M.C.P.); (S.L.V.)
| | - Alberta Rizzuti
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168 Rome, Italy; (D.P.); (G.D.); (M.C.); (C.M.); (A.R.); (M.C.P.); (S.L.V.)
| | - Maria Clara Pacilli
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168 Rome, Italy; (D.P.); (G.D.); (M.C.); (C.M.); (A.R.); (M.C.P.); (S.L.V.)
| | - Tiziana Di Cesare
- Unit of Otorhinolaryngology and Head-Neck Surgery, “A. Gemelli” University Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (M.R.); (T.D.C.); (J.G.)
| | - Simone Lo Verde
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168 Rome, Italy; (D.P.); (G.D.); (M.C.); (C.M.); (A.R.); (M.C.P.); (S.L.V.)
| | - Angela Rizzi
- Unit of Allergology e Clinical Immunology, “A. Gemelli” Hospital Foundation IRCCS, 00168 Rome, Italy; (A.R.); (R.C.)
| | - Raffaella Chini
- Unit of Allergology e Clinical Immunology, “A. Gemelli” Hospital Foundation IRCCS, 00168 Rome, Italy; (A.R.); (R.C.)
| | - Jacopo Galli
- Unit of Otorhinolaryngology and Head-Neck Surgery, “A. Gemelli” University Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (M.R.); (T.D.C.); (J.G.)
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168 Rome, Italy; (D.P.); (G.D.); (M.C.); (C.M.); (A.R.); (M.C.P.); (S.L.V.)
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Frankenberger H, Wiebringhaus R, Paul B, Huber P, Haubner F, Gröger M, Stihl C. The use of biologics in patients suffering from chronic rhinosinusitis with nasal polyps - a 4-year real life observation. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08790-y. [PMID: 38977481 DOI: 10.1007/s00405-024-08790-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/12/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE Antibody therapy for chronic rhinosinusitis with nasal polyps (CRSwNP) has been established in Germany since 2019. With limited long-term data on biologic treatment for CRSwNP, we conducted a comprehensive evaluation of our 4-year data. This monocentric study aims to assess the real-world effects of this treatment on clinical course, quality of life, treatment adherence, biologic switching, dual therapy, and comorbidities. METHODS We retrospectively analysed biologic therapy data in patients with severe chronic rhinosinusitis with nasal polyps. 191 patients with CRSwNP treated with Dupilumab, Mepolizumab, or Omalizumab were observed for up to 4 years in a real-life setting. RESULTS We observed clear symptom improvements with few side effects. No loss of efficacy or tolerability was noted during the 4-year period. Patients reported high satisfaction compared to previous therapies, with overall improved quality of life. Revision surgery or oral steroid use during biologic therapy was rare. Some patients prolonged injection intervals or discontinued steroid nasal spray. Biologic switching occurred infrequently due to side effects or inadequate response and was generally well tolerated. Many patients reported additional positive effects such as asthma or allergy symptom improvement and reduced medication intake. CONCLUSION In summary, this study confirms the potency and tolerability of biologics for CRSwNP treatment, with sustained efficacy over 4 years. Biologic switching is a viable option for inadequate response or intolerable side effects. Therapy positively impacts Th2 comorbidities, corticosteroid requirements, surgery need, and overall compliance remains high. CLINICAL TRIAL REGISTRATION Project No.: 22-0802. Registry name: Biologika bei Patient*innen mit chronischer Sinusitis mit Nasenpolypen.
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Affiliation(s)
- Hanna Frankenberger
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig Maximilian University of Munich, Munich, Germany.
| | - Robert Wiebringhaus
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Amper Hospital Dachau, Dachau, Germany
| | - Benedikt Paul
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Patrick Huber
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Frank Haubner
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Moritz Gröger
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Clemens Stihl
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig Maximilian University of Munich, Munich, Germany
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De Corso E, Baroni S, Settimi S, Onori ME, di Cesare T, Mastrapasqua RF, Sarlo F, Penazzi D, D'Agostino G, D'Auria LM, De Maio G, Fetoni AR, Galli J. Correlation between inflammatory biomarkers and disease control in chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2024; 14:1195-1205. [PMID: 38266634 DOI: 10.1002/alr.23319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) may have a heterogeneous response to medical/surgical treatments based on endotypes. Data correlating biomarkers and severity of the disease are lacking. We aimed to determine if IL-5 and calprotectin may be useful in defining severity of disease and identifying uncontrolled patients. METHODS This was a case-control study including 81 patients with diffuse CRSwNP who underwent at least one previous surgery and treated with intranasal steroids. We enrolled 39 uncontrolled patients (SNOT-22 ≥ 40 and two or more cycles of systemic corticosteroids in last year) (Group A) and 42 controlled one (SNOT-22 < 40 and less than two cycles of systemic corticosteroids in last year) (Group B). We analyzed IL-5 and calprotectin in both nasal secretions and nasal polyp tissue. RESULTS Calprotectin and IL-5 were significantly higher in Group A in both secretions and tissue, and the higher the number of previous surgeries, the higher the levels detected in nasal secretions. At univariate analyses, smoking, asthma, non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (NSAID-ERD), blood eosinophilia, neutrophils, and eosinophils at nasal cytology were significantly associated with uncontrolled disease. Multivariate analyses showed that asthma, NSAID-ERD, and IL-5 in nasal secretion/polyp tissue were significantly related to the risk of uncontrolled disease. CONCLUSIONS Our data suggest that asthma, NSAID-ERD, and IL-5 in nasal secretions/tissue may be helpful to identify more severe patients, as they are related to the risk of uncontrolled disease. Nonetheless, high levels of calprotectin and neutrophilia were also observed in uncontrolled patients, especially after multiple surgeries.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvia Baroni
- Unit of Chemistry, Biochemistry and Molecular Biology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Settimi
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Elisabetta Onori
- Molecular and Genomic Diagnostics Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Tiziana di Cesare
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Francesca Sarlo
- Unit of Chemistry, Biochemistry and Molecular Biology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniele Penazzi
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe D'Agostino
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Leandro Maria D'Auria
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriele De Maio
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Rita Fetoni
- Department of Neuroscience, Reproductive Sciences and Dentistry-Audiology Section, Università degli studi di Napoli Federico II, Naples, Italy
| | - Jacopo Galli
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
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De Corso E, Porru DP, Corbò M, Montuori C, De Maio G, Mastrapasqua RF, Panfili M, Spanu C, Di Bella GA, D'Agostino G, Rizzuti A, Passali GC, Galli J. Comparative real-world outcomes of dupilumab versus endoscopic sinus surgery in the treatment of severe CRSwNP patients. Clin Otolaryngol 2024; 49:481-489. [PMID: 38711363 DOI: 10.1111/coa.14172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/25/2024] [Accepted: 04/20/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Management of severe chronic rhinosinusitis with nasal polyps (CRSwNP) has changed significantly in recent years, with different treatments now available including biologics and endoscopic sinus surgery (ESS), although there are still few comparative studies. We aimed to compare 1-year outcomes of patients with severe CRSwNP treated with dupilumab or ESS plus intranasal corticosteroids (INCS). METHODS In this retrospective, real-life, observational, cohort study, we enrolled 101 patients with severe CRSwNP who were treated with INCS and either ESS (n = 49) or dupilumab (n = 52). The following outcomes were considered: nasal polyp score (NPS), Sino Nasal Outcome Test-22 (SNOT-22), visual analogue scale (VAS) for specific symptoms, Sniffin' Sticks identification test (SSIT), need for oral corticosteroids (OCS) and local eosinophilia detected by nasal cytology. RESULTS ΔNPS was significantly higher in the surgery group up to 12 months when the difference with dupilumab group was no longer significant (ΔNPS: 4 vs. 4.1). ΔVAS rhinorrhoea, ΔVAS smell and ΔSNOT-22 were significantly higher in the dupilumab group at 12 months (p < .05). SSIT scores were significantly better in the dupilumab group starting from the first month of follow-up (p < .05). In the dupilumab group, only 6.1% of patients had detectable local eosinophilia compared to 57% in the surgery group alongside with a lower need for OCS (16.3% vs. 61%). CONCLUSIONS Both dupilumab and ESS were effective in improving outcomes in patients with severe CRSwNP over 12 months. Nevertheless, patients treated with dupilumab had greater improvement in terms of SNOT-22, VAS rhinorrhoea, VAS smell and SSIT scores, with better control of local inflammation and less need for OCS.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology and Head-Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Rome, Italy
| | - Davide Paolo Porru
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | - Marco Corbò
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | - Claudio Montuori
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | - Gabriele De Maio
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | | | - Marco Panfili
- Unit of Radiology, "A. Gemelli" University Hospital Foundation IRCCS, Rome, Italy
| | - Camilla Spanu
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | | | - Giuseppe D'Agostino
- Unit of Otorhinolaryngology and Head-Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Rome, Italy
| | - Alberta Rizzuti
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | - Giulio Cesare Passali
- Unit of Otorhinolaryngology and Head-Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Rome, Italy
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | - Jacopo Galli
- Unit of Otorhinolaryngology and Head-Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Rome, Italy
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
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Tanzini U, Rampi A, Vinciguerra A, Danè G, Yacoub MR, Bussi M, Trimarchi M. Dupilumab: a delayed response in asthmatic and atopic patients treated for chronic rhinosinusitis with nasal polyps. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08738-2. [PMID: 38850424 DOI: 10.1007/s00405-024-08738-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/12/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a common disease, which was previously approached with sinus surgery or systemic corticosteroids. The advent of biological therapies radically changed the approach to this disease. On the other hand, there is scarce scientific evidence of how specific subsets of patients respond to this treatment. METHODS this is a monocentric, prospective study investigating the long-term efficacy on biweekly 300 mg dupilumab therapy in CRSwNP, prescribed to 61 patients. Patients were evaluated at baseline and every 2 months for the first 6 months, then at 9, 12, 16, 20 and 24 months. RESULTS dupilumab proved to be an effective treatment, neatly improving both subjective and objective measurements in CRSwNP. The main finding of the study is the difference between specific subgroups of patients: while the overall response is similar, patients with Th2 comorbidities such as asthma and atopy tend to reach a stable response later, with the improvement ongoing even after 6 months of therapy, while non-asthmatic, non-atopic patients attain an earlier stability in response. CONCLUSIONS dupilumab provides an excellent long-term control of CRSwNP, but the response in asthmatic and atopic patients appears to be different and delayed when compared to non asthmatic and non atopic ones.
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Affiliation(s)
- Umberto Tanzini
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Rampi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Giulia Danè
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Mona Rita Yacoub
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Trimarchi
- Department of Otolaryngology-Head and Neck Surgery, Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, Lugano, Switzerland.
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
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Giombi F, Pace GM, Nappi E, Giunta G, Muci G, Pirola F, Ferreli F, Heffler E, Paoletti G, Giannitto C, Mercante G, Francone M, Spriano G, Canonica GW, Malvezzi L. Radiological Versus Clinical 1-Year Outcomes of Dupilumab in Refractory CRSwNP: A Real-Life Study. Laryngoscope 2024; 134:2626-2633. [PMID: 38126613 DOI: 10.1002/lary.31238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To provide real-life evidence on long-term radiological changes in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) treated with dupilumab, and to assess possible differences between radiological and clinical results in terms of endoscopic findings and Patient-Reported-Outcomes (PROs). METHODS Consecutive patients treated with dupilumab for recalcitrant CRSwNP were required to undergo CT scan at baseline (T0) and after 12 (T1) since first administration. A group of patients also performed CT scan at 52 weeks (T2) to assess long-term outcomes. At each timepoint, patients underwent nasal endoscopy, assessment of Nasal-Polyp-Score (NPS), Lund-Kennedy-Score (LKS), and had to fill in the 22-item Sinonasal-Outcome-Test (SNOT-22) and Visual-Analogue-Scales (VAS) for sinonasal symptoms. RESULTS In fifty-three included patients, from T0 to T1 we detected a significant reduction in mean Lund-Mackay score (LM), PROs (SNOT-22, VAS) and endoscopic (NPS, LKS) scores (p < 0.05). In the subset of patients that reached T2 (n = 30), compared to T1, we observed a further significant decrease in mean LM, SNOT-22, VAS, and NPS scores, but not in LKS (p = 0.420). At T1, the highest improvement was observed in PROs (SNOT-22: 56.26%), and polyp size (NPS: 49.83%). Conversely, between T1 and T2, sinus opacification was shown to be the most improved outcome (LM: 36.86%). CONCLUSIONS Our experience showed that poorly controlled CRSwNP patients treated with dupilumab experienced significant improvement in radiologic, endoscopic and clinical disease severity. While in the initial 3 months, PROs garnered attention for showing earlier effectiveness, radiological outcomes revealed sustained and gradual efficacy in a longer term. LEVEL OF EVIDENCE Level 4. According to the Oxford Center for Evidence-Based Medicine 2011 level of evidence guidelines, this non-randomized retrospective cohort study is classified as level 4 evidence Laryngoscope, 134:2626-2633, 2024.
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Affiliation(s)
- Francesco Giombi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Emanuele Nappi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gianmarco Giunta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanna Muci
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Francesca Pirola
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Otorhinolaryngology Head & Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Caterina Giannitto
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Otorhinolaryngology Head & Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Milan, Italy
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Passali CG, Santantonio M, Passali D. The current possibilities of diagnosing and therapies for olfactory disorders. Expert Opin Pharmacother 2024; 25:973-983. [PMID: 38935483 DOI: 10.1080/14656566.2024.2368243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 06/11/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Olfactory disorders significantly affect individuals, diminishing their capacity to detect dangers, appreciate flavors, and engage socially. Despite their considerable impact on quality of life, these disorders often receive less attention compared to other sensory impairments. This review emphasizes the importance of olfactory function and explores both traditional and innovative diagnostic and therapeutic approaches. AREAS COVERED This review comprehensively covers the pathophysiology, diagnostic challenges, and treatment options for olfactory disorders. It delves into the nuances of different disorders, such as anosmia and parosmia, and discusses the array of diagnostic tools from traditional sniff tests to advanced imaging techniques. The review also evaluates therapeutic strategies, from pharmacological treatments to emerging therapies like electrical stimulation and regenerative medicine, highlighting recent advances in the field. EXPERT OPINION Current insights suggest a growing recognition of the significance of olfactory disorders, driven by recent pandemics and advances in diagnostic and therapeutic technologies. Future perspectives indicate a promising direction toward more personalized medicine approaches and enhanced regenerative therapies. Continuous research and improved clinical awareness are critical for evolving the management strategies of olfactory impairments, potentially leading to better patient outcomes and quality of life enhancements.
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Affiliation(s)
- Cesare Giulio Passali
- Division of Otorhinolaryngology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariaconsiglia Santantonio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Desiderio Passali
- IFOS Former President, ORL Head and Neck Surgery, University of Siena, Siena, Italy
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Munari S, Ciotti G, Cestaro W, Corsi L, Tonin S, Ballarin A, Floriani A, Dartora C, Bosi A, Tacconi M, Gialdini F, Gottardi M, Menzella F. Severe hypereosinophilia in a patient treated with dupilumab and shift to mepolizumab: the importance of multidisciplinary management. A case report and literature review. Drugs Context 2024; 13:2024-3-5. [PMID: 38817801 PMCID: PMC11139165 DOI: 10.7573/dic.2024-3-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/25/2024] [Indexed: 06/01/2024] Open
Abstract
Type 2 inflammation is a heterogeneous condition due to the complex activation of different immunological pathways. Rapid progress in research to evaluate the efficacy of biologics for chronic rhinosinusitis with nasal polyps and asthma has led to the availability of effective therapeutic options. These drugs are safe, but temporary iatrogenic hypereosinophilia may sometimes be associated with clinical symptoms or organ damage. Here, we describe a case of severe hypereosinophilia in a patient with chronic rhinosinusitis with nasal polyps and asthma treated with dupilumab and a subsequent therapeutic shift to mepolizumab that led to maintenance of symptom control and concomitant normalization of blood eosinophil count.
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Affiliation(s)
- Sara Munari
- Otolaryngology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
- Pulmonology and Otolaryngology Multidisciplinary Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Giulia Ciotti
- Onco Hematology, Department of Oncology, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Walter Cestaro
- Otolaryngology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
- Pulmonology and Otolaryngology Multidisciplinary Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Lorenzo Corsi
- Pulmonology and Otolaryngology Multidisciplinary Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Silvia Tonin
- Pulmonology and Otolaryngology Multidisciplinary Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Andrea Ballarin
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Ariel Floriani
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Cristina Dartora
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Annamaria Bosi
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Matteo Tacconi
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Francesco Gialdini
- Otolaryngology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Michele Gottardi
- Onco Hematology, Department of Oncology, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Francesco Menzella
- Pulmonology and Otolaryngology Multidisciplinary Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
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9
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Reale M, Licci G, Orlando P, Matucci A, Trabalzini F, Maggiore G, Gallo O. Efficacy and safety of dupilumab in the treatment of CRSwNP in the real-life setting: a review of the literature. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08725-7. [PMID: 38762844 DOI: 10.1007/s00405-024-08725-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/04/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION The recent approval of Dupilumab has profoundly revolutionized the management of patients affected by severe and recalcitrant Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). However, a review that summarizes the results of real-life studies and compares them to phase 3 studies SINUS-24 and 52 is still lacking. MATERIALS AND METHODS A search of all real-life studies published from 2019 to 2023 was performed. Patients characteristics at baseline and 6 and 12 months after starting Dupilumab were extracted and compared to those from phase 3 trials: age, sex, smoking habits, comorbid asthma and aspirin-exacerbated respiratory disease (AERD), previous endoscopic sinus surgery (ESS), hematic eosinophils and total IgE, NasalAQ2 Polyps Score (NPS), smell, SNOT-22, adverse events (AEs), and response to treatment. RESULTS 15 papers were included with an overall number of 1658 patients. A higher rate of comorbidities and previous ESS was found in patients from real-life studies. In addition, they had worse smell and SNOT-22 at baseline compared to patients from SINUS-24 and 52. Comorbid and post-ESS patients tended to have a faster NPS and SNOT-22 improvement, although the absolute values were not clinically relevant. A more extensive surgery and a number of ESS ≥ 2 were related to worse olfactory outcomes, probably due to iatrogenic damage. No correlation was found between hematic eosinophils and outcomes. AEs were reported by 12.4% of patients and 2.2% had to discontinue dupilumab. Weight gain was an emergent AE (0.8%), probably related to the restored sense of smell and taste. Non-responders were 3.5% and they were switched to systemic steroid, ESS, or another biologic. CONCLUSION Despite some differences in prescription criteria between countries, dupilumab was demonstrated to be effective even in the real-life scenario. However, emerging AEs and possible unknown long-term AEs of a likely lifelong therapy should be considered.
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Affiliation(s)
- Marella Reale
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy
- Department of Otorhinolaryngology, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giuseppe Licci
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy
| | - Pietro Orlando
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy.
| | - Andrea Matucci
- Department of Immunology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Franco Trabalzini
- Department of Otorhinolaryngology, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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10
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De Corso E, Montuori C, Baroni S, Mastrapasqua RF, Porru DP, D'Auria LM, D'Agostino G, Penazzi D, De Maio G, Onori ME, Sarlo F, Corbo' M, Galli J. Temporal trends of blood eosinophilia in severe uncontrolled CRSwNP treated with dupilumab: a real-life study. Eur Arch Otorhinolaryngol 2024; 281:2429-2440. [PMID: 38157036 DOI: 10.1007/s00405-023-08417-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Induced eosinophilia is commonly related to dupilumab treatment. We analysed the temporal trends of blood eosinophilia in patients with severe uncontrolled CRSwNP during the first year of treatment with dupilumab in real-life setting to evaluate its correlation with outcomes of response and adverse events (AEs). METHODS Seventy-four patients with severe uncontrolled CRSwNP treated with dupilumab at our institution were enrolled. At each visit, we evaluated AEC, outcomes of response to treatment and AEs. RESULTS A significant increase in AEC was observed since the first month with a peak at 3 months; at 12 months, the values returned comparable to those at baseline. A ≥ 50% increase of the baseline AEC with a value greater than 500 cells/mm3 was documented in 38/74 patients (Group A) regardless of the time of observation, whereas in 36/74 patients (Group B), no changes were observed. Analysing the blood eosinophilia trend over time in group A, we observed a temporary eosinophilia with early onset (within 6 months), persistent eosinophilia with early onset, and eosinophilia with late onset. No differences in terms of outcomes of response to treatment or AEs were found between Group A and Group B, or between patients who developed an AEC ≥ 1500 cells/mm3 or not. CONCLUSION In our series, we observed that an increase in AEC with different temporal trends may be observed in CRSwNP patients during the first year of treatment with dupilumab. In our series, eosinophilia is not correlated with a negative outcome of response to treatment or a risk of AEs.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology and Head-Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, 00168, Rome, Italy
| | - Claudio Montuori
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168, Rome, Italy.
| | - Silvia Baroni
- Unit of Chemistry, Biochemistry and Molecular Biology, "A. Gemelli" Hospital Foundation IRCCS, 00168, Rome, Italy
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Catholic University of Sacred Heart, 00168, Rome, Italy
| | | | - Davide P Porru
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Leandro M D'Auria
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Giuseppe D'Agostino
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Daniele Penazzi
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Gabriele De Maio
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Maria E Onori
- Unit of Chemistry, Biochemistry and Molecular Biology, "A. Gemelli" Hospital Foundation IRCCS, 00168, Rome, Italy
| | - Francesca Sarlo
- Unit of Chemistry, Biochemistry and Molecular Biology, "A. Gemelli" Hospital Foundation IRCCS, 00168, Rome, Italy
| | - Marco Corbo'
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Jacopo Galli
- Unit of Otorhinolaryngology and Head-Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, 00168, Rome, Italy
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168, Rome, Italy
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11
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Suzaki I, Maruyama Y, Kamimura S, Hirano K, Nunomura S, Izuhara K, Kobayashi H. Residual nasal polyp tissue following dupilumab therapy is associated with periostin-associated fibrosis. Eur Arch Otorhinolaryngol 2024; 281:1807-1817. [PMID: 37979011 DOI: 10.1007/s00405-023-08336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Dupilumab, an anti-interleukin-4 receptor alpha monoclonal antibody, is a new treatment for severe uncontrolled chronic rhinosinusitis with nasal polyps. However, data on the effect of dupilumab on histological changes in nasal polyp tissue are lacking. We aimed to investigate the effect of dupilumab on real-life clinical conditions and nasal polyp tissues from patients with eosinophilic chronic rhinosinusitis (ECRS), which is a refractory subtype. METHODS We conducted an open-label, prospective, observational, single-centre study on 63 patients with refractory ECRS on the basis of the criteria of the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis Study. These patients had a history of surgery and received dupilumab for 24 weeks. Patient-reported sinonasal symptoms, T&T olfactometry and nasal polyp scores were prospectively evaluated. In 23 patients with residual nasal polyps following dupilumab treatment, changes in systemic and local periostin expression, and total collagen deposition in nasal polyp tissues were investigated before and after dupilumab administration. RESULTS Dupilumab rapidly improved sinonasal symptoms and reduced the nasal polyp score 24 weeks after initiation. 40 (63.5%) patients had resolution of nasal polyps, but the reduction was limited in the remaining 23 (36.5%) patients. Periostin expression in serum and nasal lavage fluid was decreased, whereas periostin and the total collagen deposition area in subepithelial tissues in residual nasal polyps were enhanced after dupilumab administration. CONCLUSION Dupilumab improves sinonasal symptoms and reduces the nasal polyp score in refractory ECRS. Periostin-associated tissue fibrosis may be involved in the differential effect of dupilumab on nasal polyp reduction.
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Affiliation(s)
- Isao Suzaki
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai Shinagawa-Ku, Tokyo, 142-8666, Japan.
| | - Yuki Maruyama
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai Shinagawa-Ku, Tokyo, 142-8666, Japan
| | - Sawa Kamimura
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai Shinagawa-Ku, Tokyo, 142-8666, Japan
| | - Kojiro Hirano
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai Shinagawa-Ku, Tokyo, 142-8666, Japan
| | - Satoshi Nunomura
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan
| | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan
| | - Hitome Kobayashi
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai Shinagawa-Ku, Tokyo, 142-8666, Japan
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12
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Alicandri-Ciufelli M, Marchioni D, Pipolo C, Garzaro M, Nitro L, Dell'Era V, Ferrella F, Campagnoli M, Russo P, Galloni C, Ghidini A, De Corso E, Lucidi D. Influence of Prior Endoscopic Sinus Surgery Extent on Dupilumab Effectiveness in CRSwNP Patients. Laryngoscope 2024; 134:1556-1563. [PMID: 37632705 DOI: 10.1002/lary.30983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Guidelines recommend that the vast majority of patients with severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) should have at least one endoscopic sinus surgery (ESS) prior to starting biologics. Because ESS can be performed with a variable extension, the aim of this study would be to evaluate the association between surgical extensiveness, as measured by ACCESS score, and outcomes collected in patients treated with Dupilumab. MATERIALS AND METHODS This is a multicentric retrospective study; patients affected by CRSwNP who were subjected to Dupilumab therapy and who underwent at least one ESS prior to Dupilumab initiation were included. ACCESS score was assigned to each patient's pre-Dupilumab CT scan. Subjective and objective parameters (SNOT-22, NPS, VAS scores, Sniffin' Sticks) were collected before and during the administration of therapy. Statistical correlations between ACCESS scores and clinical outcomes were investigated. RESULTS A total of 145 patients were included; mean time from last previous ESS was 68.6 months, and on average, patients were subjected to 2.2 surgeries. Many correlations with ACCESS scores were demonstrated: better NPS at all timepoints and subjective scores (30-days SNOT-22, VAS nasal obstruction, and rhinorrhea) were achieved in patients with low ACCESS score (more extensive ESS). On the other hand, significantly worse VAS loss of smell values were demonstrated in patients with lower ACCESS scores. CONCLUSION Dupilumab patients subjected to a prior extensive ESS may have reduced size of polyps and improved subjective indicators, together with a decreased chance to recover smell, when compared with patients who underwent a minimal excision. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1556-1563, 2024.
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Affiliation(s)
- Matteo Alicandri-Ciufelli
- Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Daniele Marchioni
- Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | | | - Letizia Nitro
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Valeria Dell'Era
- ENT Division, Eastern Piedmont University Hospital of Novara, Novara, Italy
| | - Francesco Ferrella
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Massimo Campagnoli
- ENT Division, Eastern Piedmont University Hospital of Novara, Novara, Italy
| | - Paolo Russo
- ENT Department, Azienda USL Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Costanza Galloni
- Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Angelo Ghidini
- ENT Department, Azienda USL Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Eugenio De Corso
- Department of Head, Neck and Sensory Organs, A. Gemelli University Hospital IRCCS, Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
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13
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Gal A, Gravier-Dumonceau R, Penicaud M, Ebode D, Radulesco T, Michel J. Efficacy of dupilumab in real-life settings: a STROBE study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08553-9. [PMID: 38498194 DOI: 10.1007/s00405-024-08553-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Dupilumab, a monoclonal antibody targeting IL-4 and IL-13, has demonstrated its efficacy in several clinical trials. However, to date, real-life data remains limited. OBJECTIVE The aim of our study was to assess the real-life impact of dupilumab on patients with severe and uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) quality of life. MATERIALS AND METHODS This was a retrospective, monocentric, observational, real-life study, conducted in accordance with the STROBE guidelines. The following parameters were collected before treatment and at 1, 4, and 12 months: Sino-Nasal Outcome Test-22 (SNOT-22), nasal polyp score (NPS), Sniffin' Sticks-16 (SST-16), visual analog scale (VAS) for loss of smell, nasal congestion score (NCS), gustatory VAS, asthma control, oral corticosteroid usage, surgery rates, and occurrence of side effects. RESULTS The study included 47 patients. SNOT-22 scores decreased from 52.4 ± 24.3 to 12.7 ± 10.5 at 12 months (p < 0.001). NPS decreased from 6.15 ± 1.71 to 1.57 ± 1.40 at 12 months (p < 0.001). SST-16 scores increased from 1.6 ± 2.83 to 9.1 ± 5.4 at 12 months (p < 0.001). NCS decreased from 2.45 ± 0.72 to 0.38 ± 0.63 at 12 months (p < 0.001). Prior to treatment, 72.3% were using oral corticosteroids, compared to 17.0% at 12 months (p < 0.01). Two patients required additional surgery, and 17% reported completely uncontrolled asthma, compared to 0% at 12 months (p < 0.01). CONCLUSION Our real-life results confirm the efficacy of Dupilumab in the treatment of severe and uncontrolled CRSwNP.
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Affiliation(s)
- A Gal
- APHM, La Conception University Hospital, ENT-HNS, Department, Aix Marseille Univ, Marseille, France
| | - R Gravier-Dumonceau
- APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de La Communication, Aix Marseille Univ, Marseille, France
| | - M Penicaud
- APHM, La Conception University Hospital, ENT-HNS, Department, Aix Marseille Univ, Marseille, France
| | - D Ebode
- APHM, La Conception University Hospital, ENT-HNS, Department, Aix Marseille Univ, Marseille, France
| | - T Radulesco
- Aix Marseille Univ, APHM, CNRS, IUSTI, La Conception University Hospital, ENT-HNS, Department, Marseille, France, Aix Marseille Univ, Marseille, France.
| | - J Michel
- Aix Marseille Univ, APHM, CNRS, IUSTI, La Conception University Hospital, ENT-HNS, Department, Marseille, France, Aix Marseille Univ, Marseille, France
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14
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Orlando P, Licci G, Kuitche D, Matucci A, Vultaggio A, Gallo O, Maggiore G. Effectiveness of dupilumab versus endoscopic sinus surgery for the treatment of type-2 chronic rhinosinusitis with nasal polyps: a preliminary report. Eur Arch Otorhinolaryngol 2024; 281:1317-1324. [PMID: 37910208 DOI: 10.1007/s00405-023-08309-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Historically managed with intranasal corticosteroids (INCS) and endoscopic sinus surgery (ESS), type-2 Chronic RhinoSinusitis with Nasal Polyps (CRSwNP) treatment was revolutionized by the introduction of dupilumab but universally accepted guidelines are still lacking. METHODS Patients treated at our University Hospital for type-2 CRSwNP were enrolled. Demographic data were collected, as well as laboratory (eosinophils, total IgE), endoscopic [nasal polyps score (NPS), modified Lund-Kennedy score (mLKS)], radiological [Lund-Mackay score (LMS) at CT scan], SNOT-22, and olfactory [Sniffin' Sticks identification test (SSIT)] features. Patients were treated with dupilumab or ESS and re-evaluated after 3 and 12 months. RESULTS At 3 and 12 months, patients undergoing ESS achieved a higher reduction of NPS and mLKS, while patients receiving dupilumab experienced a higher improvement at SNOT-22 and SSIT with a greater positive variation in the prevalence of anosmia (- 57.7% vs - 42.9%) and normosmia (+ 37.8 vs + 28.5%). Mean mLKS and LMS were quite similar. Results were independent of clinical features known to contribute to CRSwNP severity, except for patients with ≥ 2 prior ESS who had a significantly lower smell improvement. CONCLUSION ESS and dupilumab were effective at reducing CRSwNP inflammatory burning. CRSwNP smell impairment cannot be attributed only to olfactory cleft obstruction and other mechanisms may be involved. Dupilumab acts systemically with poor correlation with NPS. As of today, dupilumab appears to be more suitable for elderly patients with anesthesiological contraindications and/or several previous surgeries, while ESS may represent the first-line choice in surgery-naive patients.
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Affiliation(s)
- Pietro Orlando
- Department of Otorhinolaryngology, Careggi University Hospital, Florence-Largo Brambilla, 3-50134, Florence, Italy.
| | - Giuseppe Licci
- Department of Otorhinolaryngology, Careggi University Hospital, Florence-Largo Brambilla, 3-50134, Florence, Italy
| | - Donald Kuitche
- Department of Otorhinolaryngology, Careggi University Hospital, Florence-Largo Brambilla, 3-50134, Florence, Italy
| | - Andrea Matucci
- Immunoallergoly Unit, Careggi University Hospital, Florence-Largo Brambilla, 3-50134, Florence, Italy
| | - Alessandra Vultaggio
- Immunoallergoly Unit, Careggi University Hospital, Florence-Largo Brambilla, 3-50134, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence-Largo Brambilla, 3-50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Florence-Largo Brambilla, 3-50134, Florence, Italy
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15
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Bachert C, Khan AH, Lee SE, Hopkins C, Peters AT, Fokkens W, Praestgaard A, Radwan A, Nash S, Jacob-Nara JA, Deniz Y, Rowe PJ. Prevalence of type 2 inflammatory signatures and efficacy of dupilumab in patients with chronic rhinosinusitis with nasal polyps from two phase 3 clinical trials: SINUS-24 and SINUS-52. Int Forum Allergy Rhinol 2024; 14:668-678. [PMID: 37548085 DOI: 10.1002/alr.23249] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND This post hoc analysis of the international SINUS-24/-52 trials (NCT02912468/NCT02898454) aimed to assess dupilumab efficacy in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) according to different definitions of type 2 inflammatory signature. METHODS Six definitions of type 2 inflammation were used: ≥150 eosinophils/μL or total immunoglobulin E (IgE) ≥100 IU/mL with a coexisting type 2 condition; ≥150 eosinophils/μL or total IgE ≥100 IU/mL; ≥150 eosinophils/μL; ≥250 eosinophils/μL or total IgE ≥100 IU/mL; coexisting asthma or ≥300 eosinophils/μL; presence of a coexisting type 2 condition. Odds ratios (ORs; dupilumab vs. placebo) for achieving clinically meaningful improvement (≥1 point) from baseline to week 24 (pooled SINUS-24/-52) and week 52 (SINUS-52) were calculated for nasal polyp score (NPS; range 0-8), nasal congestion/obstruction score (NC; 0-3), and loss of smell score (LoS; 0-3). RESULTS At baseline (n = 724), most patients displayed a type 2 inflammatory signature across definitions (64.2%-95.3%). At week 24, ORs for clinically meaningful improvement ranged from 11.9 to 14.9 for NPS across type 2 definitions, 6.5-9.6 for NC, and 12.2-17.8 for LoS (all p < 0.0001). OR ranges were similar or greater at week 52: 19.0-36.6, 7.6-12.1, and 9.2-33.5, respectively (all p < 0.0001). CONCLUSION Most patients with CRSwNP in the SINUS study had type 2 inflammation. Dupilumab demonstrated robust efficacy across definitions of type 2 inflammation, consistent with its profile as an inhibitor of Interleukin-4 and Interleukin-13 signaling, key and central drivers of type 2 inflammation in CRSwNP. KEY POINTS This study assessed type 2 inflammation prevalence and dupilumab efficacy in chronic rhinosinusitis with nasal polyps according to algorithm-defined type 2 inflammation Dupilumab efficacy was similar across all type 2 definitions.
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Affiliation(s)
- Claus Bachert
- University Hospital of Münster, Münster, Germany
- Sun Yat-sen University, The First Affiliated Hospital, Guangzhou, China
- Karolinska Hospital, Stockholm University, Stockholm, Sweden
| | | | - Stella E Lee
- Division of Otolaryngology - Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Anju T Peters
- Allergy-Immunology Division and the Sinus and Allergy Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | | - Amr Radwan
- Regeneron Pharmaceuticals Inc., Uxbridge, UK
| | - Scott Nash
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | | | - Yamo Deniz
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
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Galletti C, Ragusa M, Sireci F, Ciodaro F, Barbieri MA, Giunta G, Grigaliute E, Immordino A, Lorusso F, Dispenza F, Freni F, Galletti F, Gallina S, La Mantia I, Galletti B. Dupilumab in chronic rhinosinusitis with nasal polyps: Real life data in a multicentric Sicilian experience. Am J Otolaryngol 2024; 45:104106. [PMID: 37948824 DOI: 10.1016/j.amjoto.2023.104106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness and safety of dupilumab during the first year of treatment in a real-life setting, focusing on improvement in nasal polyp score (NPS) as well as specific symptoms, quality of life and olfactory function. METHODOLOGY/PRINCIPAL A multicentric observational cohort study was carried out. A total of 170 patients were enrolled in the Otorhinolaryngology Unit of the three University Hospitals and considered for dupilumab therapy. All recorder characteristics were age (at the first dupilumab application visit), sex, smoke habits, previous local and systemic corticosteroid therapy, history of endoscopic sinus surgery, number of previous endoscopic sinus surgery, concomitant asthma, history of an allergic condition, immunoglobulin E (IgE), allergy to nonsteroidal anti-inflammatory drugs (NSAIDs), Aspirin Exacerbated Respiratory Disease (AERD), other comorbidities associated, blood eosinophils, nasal polyp score, sinonasal outcome test 22 (SNOT 22), sniffin' stick test, the start date of dupilumab therapy and number of doses of dupilumab and eventually, Dupilumab's adverse events related to administration. The Wilcoxon test for dependent samples was performed to compare variables. Statistical significance was assumed for p values < 0.05. RESULTS A statistically significant reduction in SNOT-22 and NPS was shown at the 6th and 12th month compared to baseline values (p < 0.001 for both comparisons). A statistically significant increase value at the Sniffin' sticks test was shown in the 6th and 12th month compared to baseline values (p < 0.001 for both comparisons). At the 12-month follow-up, according to EUFOREA indications, all patients were considered to remain in treatment with dupilumab and continued the treatment because of a reduced NPS, improved quality of life and a reduced need for system corticosteroids. Dupilumab seemed to be well tolerated by all patients. Any adverse effect of the drug led to the quit of biological treatment. CONCLUSIONS This multi-centric real-life study supported the effectiveness of dupilumab as an add-on therapy to intranasal corticosteroids in patients with severe uncontrolled CRSwNP in improvement of quality of life, severity of symptoms, polyp size reduction and smell function. Furthermore, our data support the safety profile of monoclonal therapy with dupilumab.
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Affiliation(s)
- Cosimo Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Martina Ragusa
- Department of Medical-Surgical Sciences and Advanced Technologies, E.N.T. Unit, P.O. "G. Rodolico", University of Catania, Catania, Italy
| | - Federico Sireci
- Otorhinolaryngology Section, Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Via del Vespro 129, 133, 90127 Palermo, Italy
| | - Francesco Ciodaro
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy
| | | | - Giorgia Giunta
- Department of Medical-Surgical Sciences and Advanced Technologies, E.N.T. Unit, P.O. "G. Rodolico", University of Catania, Catania, Italy
| | - Egle Grigaliute
- Department of Medical-Surgical Sciences and Advanced Technologies, E.N.T. Unit, P.O. "G. Rodolico", University of Catania, Catania, Italy
| | - Angelo Immordino
- Otorhinolaryngology Section, Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Via del Vespro 129, 133, 90127 Palermo, Italy
| | - Francesco Lorusso
- Otorhinolaryngology Section, Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Via del Vespro 129, 133, 90127 Palermo, Italy
| | - Francesco Dispenza
- Otorhinolaryngology Section, Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Via del Vespro 129, 133, 90127 Palermo, Italy
| | - Francesco Freni
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy
| | - Francesco Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy
| | - Salvatore Gallina
- Otorhinolaryngology Section, Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Via del Vespro 129, 133, 90127 Palermo, Italy
| | - Igo La Mantia
- Department of Medical-Surgical Sciences and Advanced Technologies, E.N.T. Unit, P.O. "G. Rodolico", University of Catania, Catania, Italy
| | - Bruno Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy
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Caminati M, De Corso E, Ottaviano G, Pipolo C, Schiappoli M, Seccia V, Spinelli FR, Savarino EV, Gisondi P, Senna G. Remission in Type 2 Inflammatory Diseases: Current Evidence, Unmet Needs, and Suggestions for Defining Remission in Chronic Rhinosinusitis with Nasal Polyps. Curr Allergy Asthma Rep 2024; 24:11-23. [PMID: 38085499 PMCID: PMC10789826 DOI: 10.1007/s11882-023-01118-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW The development of biological therapies for type 2 inflammatory diseases raises the possibility of addressing remission in those dis-immune conditions. No consensus exists for a definition of remission in chronic rhinosinusitis with nasal polyps (CRSwNP). This review aims to critically evaluate the published data to provide the basis for defining remission in CRSwNP. RECENT FINDINGS The published evidence has yet to provide an unequivocal definition on remission in type 2 inflammatory diseases, in part reflecting differences in approaches to diagnosis and follow-up. A multidimensional evaluation is necessary when considering complete remission, including clinical, inflammatory, and histologic criteria, but how to combine or tailor the three perspectives according to disease severity at baseline or timing of assessment of treatment category is yet to reach consensus. We suggest defining remission starting from the approach taken in asthma and eosinophilic esophagitis, that is, including the resolution of symptoms and improvements in objective parameters of disease severity and/or inflammatory activity. Future studies and consensuses should provide validated criteria with cutoffs for the day-to-day definition of remission. The definition of remission in CRSwNP should include the following criteria, to be verified and maintained for a period of ≥ 12 months: absence of symptoms (nasal obstruction, loss of smell, rhinorrhea as the main ones); no impact of symptoms on quality of life; no need of surgery; no chronic or rescue medications (systemic corticosteroids or antibiotics); and recovery of smell function, possibly evaluated by objective test. Assessment of underlying inflammation should also be considered once accurate and feasible biomarkers are available in clinical practice.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Eugenio De Corso
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, do A. Gemelli 8, 00168, Rome, Italy.
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padua, Italy
| | - Carlotta Pipolo
- Otorhinolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, 20142, Milan, Italy
| | - Michele Schiappoli
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Veronica Seccia
- Otolaryngology Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124, Pisa, Italy
| | - Francesca Romana Spinelli
- Rheumatology Unit, Department of Clinical Internal, Anesthesiology and Cardiovascular Science - Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Paolo Gisondi
- Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
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La Mantia I, Grigaliute E, Ragusa M, Cocuzza S, Radulesco T, Saibene AM, Calvo-Henriquez C, Fakhry N, Michel J, Maniaci A. Effectiveness and rapidity on olfatory fuction recovery in CRS patients treated with Dupilumab: a real life prospective controlled study. Eur Arch Otorhinolaryngol 2024; 281:219-226. [PMID: 37594543 DOI: 10.1007/s00405-023-08184-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Recovery of olfactory function plays a prominent role in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). While rates and timing of such recovery vary, monoclonal antibodies might yield better results which we aimed at evaluating with this study. METHODOLOGY A prospective controlled study was conducted at our tertiary otolaryngological center from April 1, 2021, to October 1, 2022, in CRSwNP patients. We included an active group (n = 60 patients) performing dupilumab treatment and a control group (n = 60 patients) treated with intranasal and oral corticosteroids. Primary endpoints were changes in smell visual analogical scale (VAS) and SS-I (Sniffin' Sticks-identification) scores, and olfactory recovery rate. The secondary efficacy endpoints were nasal obstruction, rhinorrhea, headache, SNOT-22, and nasal congestion score (NCS). RESULTS At 6 months, the active group demonstrated better outcomes than control in SS-I scores (10.23 ± 4.21 vs.3.68 ± 3.08; p < 0.001). No significant differences were found in blood eosinophil count, SNOT-22, and NPS (p > 0.05 for all). Olfactory function in the treatment arm improved in 86.66% (52/60 cases), with normal scores in 48.33% (29/60), while the control group reported a lower recovery rate (3/60; 5%), with no normal olfaction cases. Log-rank comparison for Kaplan-Meier functions was statistically significant (p < 0.001), but no differences were found in subanalysis in the active group based on blood eosinophil count at baseline, SNOT-22, and NPS scores. CONCLUSIONS Patients who receive dupilumab treatment may experience a faster recovery of olfactory function compared to those receiving corticosteroid therapy. This result would be maintained regardless of the severity of type 2 CRSwNP inflammation, the volume of the polyps, or the patient's subjective symptomatology.
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Affiliation(s)
- Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia" ENT Section, University of Catania, 95123, Catania, Italy
| | - Egle Grigaliute
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia" ENT Section, University of Catania, 95123, Catania, Italy
| | - Martina Ragusa
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia" ENT Section, University of Catania, 95123, Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia" ENT Section, University of Catania, 95123, Catania, Italy
| | - Thomas Radulesco
- ENT Surgeon, Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, Aix-Marseille Univ, 147 Bd Baille, 13005, Marseille, France
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
| | - Alberto Maria Saibene
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Otolaryngology Unit, Santi Paolo E Carlo Hospital, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Christian Calvo-Henriquez
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Nicolas Fakhry
- ENT Surgeon, Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, Aix-Marseille Univ, 147 Bd Baille, 13005, Marseille, France
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
| | - Justin Michel
- ENT Surgeon, Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, Aix-Marseille Univ, 147 Bd Baille, 13005, Marseille, France
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia" ENT Section, University of Catania, 95123, Catania, Italy.
- Rhynology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France.
- Faculty of Medicine and Surgery, University of Enna "Kore", 94100, Enna, Italy.
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19
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Rampi A, Tanzini U, Vinciguerra A, Danè G, Moroni L, Yacoub MR, Trimarchi M. Early increase in eosinophil count may predict long-term hypereosinophilia during dupilumab treatment: a 2-year observational study. Int Forum Allergy Rhinol 2023; 13:2244-2247. [PMID: 37316962 DOI: 10.1002/alr.23212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/16/2023]
Abstract
KEY POINTS In a limited subset of patients, dupilumab-induced hypereosinophilia is persistent. Two-month follow-up eosinophil count may predict long-lasting hypereosinophilia.
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Affiliation(s)
- Andrea Rampi
- Otorhinolaryngology Unit, Division of Head and Neck department, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Umberto Tanzini
- Otorhinolaryngology Unit, Division of Head and Neck department, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Giulia Danè
- Otorhinolaryngology Unit, Division of Head and Neck department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Moroni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mona-Rita Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Trimarchi
- Otorhinolaryngology Unit, Division of Head and Neck department, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Otolaryngology-Head and Neck Surgery, Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano - Università della Svizzera Italiana, Lugano, Switzerland
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Ali A, Fakunle DR, Yu V, McDermott S, Previtera MJ, Meier JC, Phillips KM, Sedaghat AR. Heterogeneity in the definition of chronic rhinosinusitis disease control: a systematic review of the scientific literature. Eur Arch Otorhinolaryngol 2023; 280:5345-5352. [PMID: 37378726 DOI: 10.1007/s00405-023-08090-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/21/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE Disease control is conceptually recognized to be an important outcome measure for chronic rhinosinusitis (CRS). However, inconsistent usage is a significant factor in disadoption of important concepts and it is presently unclear how consistently the construct of CRS 'control' is being defined/applied. The objective of this study was to determine the heterogeneity of CRS disease control definitions in the scientific literature. METHODS Systematic review of PubMed and Web of Science databases from inception through December 31, 2022. Included studies used CRS disease control as an explicitly stated outcome measure. The definitions of CRS disease control were collected. RESULTS Thirty-one studies were identified with more than half published in 2021 or later. Definitions of CRS control were variable, although 48.4% of studies used the EPOS (2012 or 2020) criteria to define control, 14 other unique definitions of CRS disease control were also implemented. Most studies included the burden CRS symptoms (80.6%), need for antibiotics or systemic corticosteroids (77.4%) or nasal endoscopy findings (61.3%) as criteria in their definitions of CRS disease control. However, the specific combination of these criteria and prior time periods over which they were assessed were highly variable. CONCLUSION CRS disease control is not consistently defined in the scientific literature. Although many studies conceptually treated 'control' as the goal of CRS treatment, 15 different criteria were used to define CRS disease control, representing significant heterogeneity. Scientific derivation of criteria and collaborative consensus building are needed for the development of a widely-accepted and -applied definition of CRS disease control.
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Affiliation(s)
- Ayad Ali
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0528, USA
| | - Damilola R Fakunle
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0528, USA
| | - Victor Yu
- University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Sean McDermott
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0528, USA
| | - Melissa J Previtera
- Health Sciences Library, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Josh C Meier
- University of Nevada, Reno School of Medicine, Reno, NV, USA
- Nevada ENT and Hearing Associates, Reno, NV, USA
| | - Katie M Phillips
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0528, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0528, USA.
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Cergan R, Berghi ON, Dumitru M, Vrinceanu D, Manole F, Serboiu CS. Biologics for Chronic Rhinosinusitis-A Modern Option for Therapy. Life (Basel) 2023; 13:2165. [PMID: 38004305 PMCID: PMC10672088 DOI: 10.3390/life13112165] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is an important ENT pathology which affects about 5-12% of the general population. The treatment of CRS can be pharmacological (nasal sprays, douches, systemic antibiotics and steroids), surgical (endoscopic sinus surgery) or immunological according to established algorithms. CRS was divided for many years into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). New ways of classifying CRS by endotypes (presence of neutrophilia, eosinophilia, fibrosis, glandular hypertrophy and epithelial dysmorphisms) appeared after the most recent understandings of the pathophysiology of the disease. Other classifications divide CRS into primary and secondary forms, localized/diffuse types and anatomical presentation. A new type of treatment has been administered in the last years, biologics. For the moment, biologics are indicated just in the cases of the patients who have undergone ESS or have contraindications for surgery and have bilateral polyps and meet a minimum of three of the following criteria: the necessity for systemic therapies with oral or parenteral corticosteroids or contraindications to systemic steroids, significant loss of smell or impaired QoL score, comorbid asthma and type 2 inflammation. This article aims to present the most relevant studies which used the three types of biologics (anti-IgE, anti-IL5 and anti-IL4/IL3) and wishes to increase the awareness of this new type of treatment that can be used in some CRS cases.
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Affiliation(s)
- Romica Cergan
- Anatomy Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Ovidiu Nicolae Berghi
- Saint Mary Laboratories and Clinics, Carol Davila University of Medicine and Pharmacy, 011013 Bucharest, Romania;
| | - Mihai Dumitru
- ENT Department, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania
| | - Daniela Vrinceanu
- ENT Department, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania
| | - Felicia Manole
- ENT Department, Faculty of Medicine, University of Oradea, 410073 Oradea, Romania;
| | - Crenguta Sorina Serboiu
- Cellular Biology and Histology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
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22
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Bellocchi G, Loperfido A, Passali FM, Millarelli S, Velletrani G, Perla M, Di Michele L, Di Girolamo S. Biologics in severe uncontrolled chronic rhinosinusitis with nasal polyps: A bicentric experience. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023227. [PMID: 37850768 PMCID: PMC10644941 DOI: 10.23750/abm.v94i5.14745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/27/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND AIM The introduction of biologics in the management of chronic rhinosinusitis with nasal polyposis (CRSwNP) has allowed new therapeutic options and Dupilumab represents the first approved biological agent. Aim of this paper is to provide a multicentric study in a real-life setting of treatment with Dupilumab for severe uncontrolled CRSwNP in Italy. METHODS A retrospective data collection was performed from the departments of Otolaryngology of two major health institutions in Rome: San Camillo Forlanini Hospital and Tor Vergata University. Both centres contributed to the study providing information about patients affected by severe uncontrolled CRSwNP and treated with Dupilumab. RESULTS A total of 83 patients were included in the study (43 males; 40 females; mean age: 55.8 years). Monitoring our patients, we observed improvement in reduction of nasal polyposis and nasal obstruction, respectively measured through NPS and PNIF. Concerning the CRSwNP symptoms and their impact on quality of life, we found an improvement in the olfaction, as measured respectively by SSIT-16 and SNOT-22. CONCLUSIONS Dupilumab has demonstrated broad efficacy in CRSwNP management. Further studies are needed to confirm our results and to establish biomarkers to identify endotypes and predict response to biologics treatment in CRSwNP.
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Affiliation(s)
- Gianluca Bellocchi
- Department of Otolaryngology, San Camillo Forlanini Hospital, Rome, Italy.
| | | | - Francesco Maria Passali
- Department of Clinical Sciences and Translational Medicine, Otorhinolaryngology Unit, Tor Vergata University of Rome, Italy..
| | - Stefano Millarelli
- Department of Otolaryngology, San Camillo Forlanini Hospital, Rome, Italy.
| | - Gianluca Velletrani
- Department of Clinical Sciences and Translational Medicine, Otorhinolaryngology Unit, Tor Vergata University of Rome, Italy..
| | - Marco Perla
- Department of Clinical Sciences and Translational Medicine, Otorhinolaryngology Unit, Tor Vergata University of Rome, Italy..
| | - Loreta Di Michele
- Department of Pulmonary Interstitial Diseases, San Camillo Forlanini Hospital, Rome, Italy.
| | - Stefano Di Girolamo
- Department of Clinical Sciences and Translational Medicine, Otorhinolaryngology Unit, Tor Vergata University of Rome, Italy..
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23
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De Corso E, Pipolo C, Cantone E, Ottaviano G, Gallo S, Trimarchi M, Torretta S, Cavaliere C, Lucidi D, Seccia V, Settimi S, Canevari FRM, Pasquini E, La Mantia I, Garzaro M, Bellocchi G, De Benedetto M, Lombardo N, Macchi A, Malvezzi L, Motta G, Vicini C, Maselli A, Dell’Era V, Dragonetti A, Asprea F, Lupato V, Ghidini A, Masieri S, Mattavelli D, Salzano FA, Passali D, Galli J, Pagella F. Practical recommendations for managing severe chronic rhinosinusitis with nasal polyps in the era of biologics. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:324-340. [PMID: 37224173 PMCID: PMC10551726 DOI: 10.14639/0392-100x-n2422] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/09/2023] [Indexed: 05/26/2023]
Abstract
Objective We conducted a national survey to understand how rhinology practice has changed with the advent of biologics and how this affected patients with uncontrolled, severe chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to analyse the results of the survey and infer practical recommendations for clinical practice. Methods A group of ear, nose, and throat specialists (ENTs) experienced in the management of CRSwNP developed a 74-question survey. ENTs from rhinology centres authorised to prescribe biologics in the context of the national health system were invited to answer it between 01/05/2022 and 31/07/2022. The responses underwent descriptive analyses, and the authors discussed the results and derived practical recommendations for clinical practice. Results ENTs working in rhinology centres changed their practices coinciding with the advent of biologics. CRSwNP evaluations have become more complex because they involve diagnostic confirmation, determining the patients' immunologic profile, and other factors. We observed heterogenous behaviours in practice that may be conditioned by the novelty of the topic. The results of the survey were used to develop practical recommendations for ENTs and are summarised herein. Conclusions Clinical practice in rhinology outpatient clinics has changed profoundly in the era of biologics. Our practical recommendations for clinicians working in rhinology centres are expected to help standardise practice and improve care.
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Affiliation(s)
- Eugenio De Corso
- Otorhinolaryngology Unit, Head and Neck Department, A. Gemelli Universitary Hospital Foundation IRCCS, Rome, Italy
| | - Carlotta Pipolo
- Otorhinolaryngology Unit, Head and Neck Department, Dipartimento di Scienze della Salute, Università degli Studi di Milano, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat, “Federico II” University, Naples, Italy
| | - Giancarlo Ottaviano
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Stefania Gallo
- Otorhinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, Varese, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Cavaliere
- Dipartimento di scienze odontostomatologiche e maxillo facciali. Sapienza University of Rome, Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology – Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Pisa University Hospital, Pisa, Italy
| | | | - Frank Rikki Mauritz Canevari
- UOC di Otorinolaringoiatria IRCCS Policlinico San Martino Genova, Dipartimento DISC Università di Genova, Genoa, Italy
| | - Ernesto Pasquini
- ENT Unit “Bellaria” Hospital – Specialized Dep AUSL Bologna, Italy
| | | | | | | | | | - Nicola Lombardo
- ENT Unit Department of Medical and Surgical Sciences, University Magna Græcia Catanzaro, Italy
| | - Alberto Macchi
- ENT University of Insubria, ASST Settelaghi, Varese, Italy
| | - Luca Malvezzi
- IRCCS Humanitas Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Rozzano (MI), Italy
| | - Gaetano Motta
- Otorhinolaryngology – Head and Neck Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Alessandro Maselli
- Department Otorhinolaryngology, Hospital of Barletta, Barletta (BT), Italy
| | - Valeria Dell’Era
- ENT Division, Maggiore Hospital, Eastern Piedmont University – Novara, Italy
| | | | - Francesco Asprea
- Otorinolaringoiatria e audiologia. Università degli studi di Messina, Messina, Italy
| | - Valentina Lupato
- Division of Otolaryngology, Ospedale Civile di Pordenone, Azienda Sanitaria Friuli Occidentale (ASFO), Pordenone, Italy
| | - Angelo Ghidini
- Otorinolaringoiatria Azienda USL di Reggio Emilia/IRCCS, Italy
| | - Simonetta Masieri
- Dipartimento di scienze odontostomatologiche e maxillo facciali. Sapienza University of Rome, Rome, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia – University of Brescia, Brescia, Italy
| | | | | | - Jacopo Galli
- Otorhinolaryngology Unit, Head and Neck Department, A. Gemelli Universitary Hospital Foundation IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
- Otorhinolaryngology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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van der Lans RJL, Otten JJ, Adriaensen GFJPM, Hoven DR, Benoist LB, Fokkens WJ, Reitsma S. Two-year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months. Allergy 2023; 78:2684-2697. [PMID: 37394895 DOI: 10.1111/all.15796] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/29/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Dupilumab is an anti-T2-inflammatory biological registered for chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), indicated by integrated CRS-care pathways when optimal medico-surgical treatment yields insufficient CRS control. This study aims to evaluate long-term results with focus on established therapeutic efficacy while tapering dupilumab. METHODS Real-life, prospective observational cohort study in single tertiary referral center with add-on dupilumab as primary biological treatment in adult (≥18 years) biological-naïve CRSwNP patients per the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS)2020-indication with a 2-year follow-up. Tapering (increasing interdose interval) applied every 24 weeks, conditional to sufficient treatment response and CRS control. RESULTS Mean scores (s.d.) of all co-primary outcomes improved significantly from baseline ( 228) to the 48 ( 214) and 96-weeks ( 99) timepoints: Nasal Polyp Score (0-8) improved from 5,3 (1,9) to 1,4 (1,8) and 1,3 (1,7); SinoNasal Outcome Test (SNOT)-22 (0-110) improved from 53,6 (19,6) to 20,2 (15,4) and 21,2 (15,6); Sniffin'Sticks-12 identification test (0-12; 0-6 anosmia, 7-10 hyposmia, 11-12 normosmia) improved from 3,7 (2,4) to 7,7 (2,9) and 7,3 (3,04); Asthma Control Test (5-25; >19 indicating well-controlled asthma) improved from 18,5 (4,8) to 21,8 (3,8) and 21,4 (3,9). Tapering was feasible in 79,5% of the patients at the 24-weeks timepoint, and in 93,7% and 95,8% at the 48- and 96-weeks timepoints, respectively. One-way repeated-measures ANOVA demonstrated no significant alterations of individual co-primary outcome mean-scores from 24 weeks onward. CONCLUSION This first long-term real-life prospective observational cohort study shows high therapeutic efficacy of dupilumab for severe CRswNP in the first 2 years. Therapeutic efficacy is principally established within 24 weeks and endures while tapering dupilumab conditional to treatment response and CRS control.
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Affiliation(s)
| | - Josje Janna Otten
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Dinand Rienk Hoven
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Linda Berendina Benoist
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wytske Johanna Fokkens
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sietze Reitsma
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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25
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De Corso E, Pasquini E, Trimarchi M, La Mantia I, Pagella F, Ottaviano G, Garzaro M, Pipolo C, Torretta S, Seccia V, Cantone E, Ciofalo A, Lucidi D, Fadda GL, Pafundi PC, Settimi S, Montuori C, Anastasi F, Pagliuca G, Ghidini A, Cavaliere C, Maffei M, Bussu F, Gallo S, Canevari FRM, Paludetti G, Galli J. Dupilumab in the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP): A multicentric observational Phase IV real-life study (DUPIREAL). Allergy 2023; 78:2669-2683. [PMID: 37203259 DOI: 10.1111/all.15772] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/08/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with significant morbidity and reduced health-related quality of life. Findings from clinical trials have demonstrated the effectiveness of dupilumab in CRSwNP, although real-world evidence is still limited. METHODS This Phase IV real-life, observational, multicenter study assessed the effectiveness and safety of dupilumab in patients with severe uncontrolled CRSwNP (n = 648) over the first year of treatment. We collected data at baseline and after 1, 3, 6, 9, and 12 months of follow-up. We focused on nasal polyps score (NPS), symptoms, and olfactory function. We stratified outcomes by comorbidities, previous surgery, and adherence to intranasal corticosteroids, and examined the success rates based on current guidelines, as well as potential predictors of response at each timepoint. RESULTS We observed a significant decrease in NPS from a median value of 6 (IQR 5-6) at baseline to 1.0 (IQR 0.0-2.0) at 12 months (p < .001), and a significant decrease in Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score of 58 (IQR 49-70) at baseline to 11 (IQR 6-21; p < .001) at 12 months. Sniffin' Sticks scores showed a significant increase over 12 months (p < .001) compared to baseline. The results were unaffected by concomitant diseases, number of previous surgeries, and adherence to topical steroids, except for minor differences in rapidity of action. An excellent-moderate response was observed in 96.9% of patients at 12 months based on EPOS 2020 criteria. CONCLUSIONS Our findings from this large-scale real-life study support the effectiveness of dupilumab as an add-on therapy in patients with severe uncontrolled CRSwNP in reducing polyp size and improving the quality of life, severity of symptoms, nasal congestion, and smell.
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Affiliation(s)
- Eugenio De Corso
- Otorhinolaryngology Unit, A.Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Ernesto Pasquini
- Otorhinolaryngology Unit, Ospedale Bellaria Dip Chirurgie Specialistiche AUSL, Bologna, Italy
| | - Matteo Trimarchi
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Ignazio La Mantia
- Department of Medical-Surgical Sciences and Advanced Technologies, E.N.T. Unit, P.O. "G. Rodolico", University of Catania, Catania, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - Massimiliano Garzaro
- Department of Otorhinolaryngology, Rhinology Unit, Eastern Piedmont University, Maggiore Hospital, Novara, Italy
| | - Carlotta Pipolo
- Otorhinolaryngology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Sara Torretta
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico", University of Milan, Milan, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, Head and Neck Department-ENT Section, University of Naples Federico II, AOU Federico II, Naples, Italy
| | - Andrea Ciofalo
- Rhinology Unit, Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Pia Clara Pafundi
- Epidemiology and Biostatistics Core Facility, Gemelli Science and Technology park, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Settimi
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
| | - Claudio Montuori
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
| | - Francesca Anastasi
- Otorhinolaryngology Unit, Ospedale San Giovanni Evangelista, Tivoli, Italy
| | - Giulio Pagliuca
- Otolaryngology University Unit, "S. M. Goretti Hospital", Latina, Italy
| | - Angelo Ghidini
- ENT Department, Azienda USL Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Carlo Cavaliere
- Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Marianna Maffei
- Otolaryngology Head and Neck Surgery Unit, AORN Ospedali della Colli, Naples, Italy
| | - Francesco Bussu
- Division of Otorhinolaryngology, Department of Medicine, Surgery and Pharmacy, Azienda Ospedaliera Universitaria di Sassari, University of Sassary, Sassari, Italy
| | - Stefania Gallo
- Otorinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, Varese, Italy
| | | | - Gaetano Paludetti
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
| | - Jacopo Galli
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
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Campion NJ, Brugger J, Tu A, Stanek V, Brkic FF, Bartosik TJ, Liu DT, Hoehl BS, Gangl K, Eckl-Dorna J, Schneider S. The "real life" efficacy of dupilumab is independent of initial polyp size and concomitant steroids in CRSwNP. J Otolaryngol Head Neck Surg 2023; 52:56. [PMID: 37674253 PMCID: PMC10481502 DOI: 10.1186/s40463-023-00663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 08/24/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Dupilumab significantly improves symptom control in chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with large polyps at the initiation of treatment (total polyp score (TPS) ≥ 5) have been the focus in published studies. Patients with significant burden of disease but small polyps (TPS ≤ 4) have not yet been evaluated for clinical response. This study set out to evaluate the benefit of dupilumab treatment on cohorts of small (TPS ≤ 4) compared to large polyps (TPS ≥ 5). Furthermore, benefit of concomitant oral and/or nasal steroid therapy has been evaluated. METHODS 97 patients with CRSwNP, who were begun on dupilumab between January 2020 and October 2021, were included. All patients were followed-up for 6 months. At each visit they underwent nasal endoscopy, smell identification tests and filled out validated patient questionnaires. RESULTS Significant drops in TPS were seen in both patient groups after 6 months of therapy, dropping from a median score of 3 to 0 and from 6 to 2 in patients with small and large polyps respectively. Furthermore, a linear mixed model calculated a drop of 22% and 24% in TPS per month in patients with small and large polyps respectively with no significant difference in rate of decline. Finally the model showed that neither oral nor nasal steroids influenced the rate of response to dupilumab therapy. CONCLUSIONS Polyp size at the initiation of dupilumab therapy and whether patients continue to take steroid therapy does not appear to influence effectiveness of dupilumab treatment.
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Affiliation(s)
- Nicholas J Campion
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jonas Brugger
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Aldine Tu
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Victoria Stanek
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Faris F Brkic
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Tina J Bartosik
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - David T Liu
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bruna S Hoehl
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katharina Gangl
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julia Eckl-Dorna
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Sven Schneider
- Department of Otorhinolaryngology, Research Laboratories 8H, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Ottaviano G, De Corso E, Saccardo T, D’Auria LM, Zampollo S, D’Agostino G, Mairani E, De Maio G, Scarpa B, Bacci C, Favero V. Effectiveness of Dupilumab in the Treatment of Adult and Older Adult Patients with Severe, Uncontrolled CRSwNP. J Pers Med 2023; 13:1241. [PMID: 37623491 PMCID: PMC10456067 DOI: 10.3390/jpm13081241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial disease that significantly impacts patients' quality of life. New therapeutic strategies and in particular biologic treatments are now available for these patients. It has been demonstrated that Dupilumab (an anti IL-4/IL-13 biologic drug) is effective in reducing the size of nasal polyps and in improving patients' symptoms and thus, quality of life. No real-world studies examining Dupilamab's efficacy in the elderly with respect to other adult age groups have as yet been carried out. The aim of this multicentric study was to evaluate Dupilumab's efficacy in young-middle adults as opposed to an older adult population affected by severe, uncontrolled CRSwNP. Of the 96 patients included in the study, 22 were 65 years old or older. Significant improvements were observed in all the parameters considered in both age groups after treatment was begun (T0 mean values for SNOT-22 = 58.5 ± 20.3, VAS NO = 7.6 ± 2.2, VAS smell = 8.6 ± 2.1, NPS = 5.6 ± 1.4, PNIF = 101.6 ± 59.4, S'S = 5.1 ± 3.1), T4 mean values for SNOT-22 = 15.1 ± 12.7, VAS NO = 1.7 ± 1.8, VAS smell = 2.4 ± 3, NPS = 1.7 ± 1.7, PNIF = 162.4 ± 43.2, S'S = 10.4 ± 3.7) (p < 0.0001). No differences in the variables considered were observed between the two age groups during the study, with the exception of the Peak Nasal Inspiratory Flow (PNIF), which was marginally higher; this was also the case according to multivariate analyses (p = 0.008) in the young-middle adult group with respect to the elderly one (p = 0.07). At multivariate analyses, asthma and the female sex negatively influenced the PNIF values (p = 0.001 and p = 0.012, respectively). Age negatively influenced the Visual Analog Scale (VAS) for nasal obstruction (p = 0.0032) and Endoscopic Sinus Surgery (ESS) negatively influenced the patents' olfactory performance (p = 0.028) to the same degree in both groups. Dupilumab was found to be effective to the same degree in both age groups. It can be considered a safe and reliable option for the treatment of elderly patients with severe, uncontrolled CRSwNP.
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Affiliation(s)
- Giancarlo Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (T.S.); (S.Z.); (E.M.)
| | - Eugenio De Corso
- Department of Otolaryngology, Policlinico Gemelli University Hospital IRCCS, 00168 Rome, Italy; (E.D.C.); (L.M.D.); (G.D.); (G.D.M.)
| | - Tommaso Saccardo
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (T.S.); (S.Z.); (E.M.)
| | - Leandro Maria D’Auria
- Department of Otolaryngology, Policlinico Gemelli University Hospital IRCCS, 00168 Rome, Italy; (E.D.C.); (L.M.D.); (G.D.); (G.D.M.)
| | - Sonny Zampollo
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (T.S.); (S.Z.); (E.M.)
| | - Giuseppe D’Agostino
- Department of Otolaryngology, Policlinico Gemelli University Hospital IRCCS, 00168 Rome, Italy; (E.D.C.); (L.M.D.); (G.D.); (G.D.M.)
| | - Edoardo Mairani
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (T.S.); (S.Z.); (E.M.)
| | - Gabriele De Maio
- Department of Otolaryngology, Policlinico Gemelli University Hospital IRCCS, 00168 Rome, Italy; (E.D.C.); (L.M.D.); (G.D.); (G.D.M.)
| | - Bruno Scarpa
- Department of Statistical Sciences, University of Padova, 35122 Padova, Italy;
| | - Christian Bacci
- Unit of Dentistry, Department of Neurosciences, University of Padua, 35122 Padova, Italy;
| | - Vittorio Favero
- Unit of Maxillofacial Surgery and Dentistry, Head and Neck Department, University of Verona, 37134 Verona, Italy;
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28
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Li T, Yin J, Yang Y, Wang G, Zhang Y, Song X. Dupilumab in chronic rhinosinusitis with nasal polyposis: current status, challenges, and future perspectives. Expert Rev Clin Immunol 2023; 19:939-948. [PMID: 37378551 DOI: 10.1080/1744666x.2023.2231150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/07/2023] [Accepted: 06/26/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Chronic sinusitis with nasal polyposis (CRSwNP) is a common heterogeneous disease that mainly manifests as chronic inflammation of the sinus mucosa. The effect of conventional treatments for CRSwNP, such as oral corticosteroids, intranasal corticosteroids (INCS) and polypectomy, is not always obvious, and postoperative recurrence is common in some CRSwNP patients. In recent years, some biologics have been shown to be very effective in treating refractory CRSwNP, of which dupilumab has attracted much attention as the first monoclonal drug approved to treat nasal polyps. AREAS COVERED In this review, we discuss the research status of dupilumab in treatment of CRSwNP and how dupilumab differs from other treatment methods. EXPERT OPINION The European Union and United States have approved dupilumab as the first biological agent for treatment of CRSwNP. Dupilumab can improve symptoms of nasal congestion or obstruction, nasal secretion, and olfactory loss in patients with CRSwNP. It can also improve a patient's health-related quality of life (HR-QoL) and reduce the need for systemic corticosteroids and nasal polyp surgery. While subcutaneous injection of dupilumab is a novel method for treating CRSwNP, it is still necessary to reasonably evaluate which patients might benefit most from biological therapy.
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Affiliation(s)
- Tong Li
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Yantai Yuhuangding Hospital, Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
- Yantai Yuhuangding Hospital, Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, China
| | - Jiali Yin
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Yantai Yuhuangding Hospital, Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
- Yantai Yuhuangding Hospital, Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, China
| | - Yujuan Yang
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Yantai Yuhuangding Hospital, Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
- Yantai Yuhuangding Hospital, Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, China
| | - Guangkuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Yantai Yuhuangding Hospital, Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
- Yantai Yuhuangding Hospital, Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, China
| | - Yu Zhang
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Yantai Yuhuangding Hospital, Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Xicheng Song
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Yantai Yuhuangding Hospital, Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
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29
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Otten J, van der Lans R, de Corso E, Dziadziulia K, Hilvering B, Weersink E, Bonini M, Hagemann J, Thaitrakool W, Montuori C, Klimek L, Reitsma S, Fokkens W. Evaluation of switching or simultaneous use of biologic treatment in patients with severe chronic rhinosinusitis with nasal polyps and severe asthma. Considerations in clinical decision making. Expert Rev Clin Immunol 2023; 19:1041-1049. [PMID: 37226507 DOI: 10.1080/1744666x.2023.2218617] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/23/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Type 2 targeting biologics have reached the market first for asthma and since 2019 also for CRSwNP. As clear guidelines and predictors for optimal biological choice are missing, patients are sometimes required to switch biologic therapy in order to find the optimal treatment result. In this paper, we evaluate reasons for switching biologics and the treatment effects after each sequential switch. MATERIALS AND METHODS Ninety-four patients who switched from one biologic to another for their treatment of CRSwNP and asthma were evaluated. RESULTS Twenty patients experienced satisfactory control of CRSwNP, but insufficient control of severe asthma. Fifty-one patients experienced satisfactory control of severe asthma, but insufficient control of CRSwNP/EOM. Twenty-eight patients experienced insufficient control of both upper and lower airways. Thirteen patients had to switch because of side effects. Furthermore, two cases are described to clarify clinical decision-making. DISCUSSION For abovementioned patients, a multidisciplinary approach is mandatory to find the best suitable biologic. It seems ineffective to switch to a second anti-IL5 treatment if the first one is not successful. Most patients that failed omalizumab and/or an anti-IL-5 treatment are well controlled on dupilumab. Therefore, we suggest to use dupilumab as first choice when switching biologic agents.
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Affiliation(s)
- Josje Otten
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rik van der Lans
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eugenio de Corso
- Unit of Otorhinolaryngology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | | | - Bart Hilvering
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Els Weersink
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Matteo Bonini
- Department of Internal Medicine and Geriatrics, Catholic University of the Sacred Hearth, Rome, Italy
| | - Jan Hagemann
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - Wanrawee Thaitrakool
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Claudio Montuori
- Head and Neck and Sensory Organs Department, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Sietze Reitsma
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wytske Fokkens
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Book R, Eligal S, Tal Y, Eliashar R. Biological Treatment for Uncontrolled Chronic Rhinosinusitis with Nasal Polyps: Preliminary Real-World Results from a Tertiary Medical Center. J Clin Med 2023; 12:jcm12113671. [PMID: 37297865 DOI: 10.3390/jcm12113671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
The efficacy of biological treatment for severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) has recently been demonstrated through double-blinded clinical trials. The aim of this study was to provide preliminary real-world experience regarding biological therapy for uncontrolled CRSwNP. The records of patients who received biological treatment in a tertiary medical center between the years 2019 to 2022 were retrospectively reviewed. Patients included in this study were eligible for biological treatment according to the EPOS 2020 criteria. Among patients who had their first follow-up visit <6 months from the treatment initiation, the Sino-Nasal Outcome Test 22 Questionnaire (SNOT-22) score had decreased by 22% (p = 0.01) and the nasal polyp score (NPS) had decreased by 48% (p = 0.05). Among patients who had their first follow-up visit ≥6 months from treatment initiation, the SNOT-22 score had decreased by 40% (p = 0.03) and the NPS had decreased by 39% (p = 0.1). The number of patients who needed systemic steroid treatment had decreased by 68% (p < 0.0001), and the number of patients who needed endoscopic sinus surgery had decreased by 74% (p < 0.0001). These findings correspond with the improvement of clinical symptoms observed in prior randomized clinical trials, thus showing the effectiveness of biologic medications in the treatment of severe CRSwNP in a real-life setting. Although further cohort studies are warranted, our study also suggests evaluating patients at follow-up visits mainly by quality-of-life aspects and investigating longer dosing intervals of dupilumab.
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Affiliation(s)
- Reut Book
- Department of Otolaryngology/Head and Neck Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Jerusalem 91120, Israel
| | - Shalom Eligal
- Hadassah Medical Center, Faculty of Medicine, Hebrew University, Jerusalem 91120, Israel
| | - Yuval Tal
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Jerusalem 91120, Israel
| | - Ron Eliashar
- Department of Otolaryngology/Head and Neck Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Jerusalem 91120, Israel
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De Corso E, Settimi S, Montuori C, Cantiani A, Corbò M, Di Bella GA, Sovardi F, Pagella F, Rigante M, Passali GC, Paludetti G, Galli J. How to manage recurrences after surgery in CRSwNP patients in the biologic era: a narrative review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S3-S13. [PMID: 37698095 PMCID: PMC10159635 DOI: 10.14639/0392-100x-suppl.1-43-2023-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 09/13/2023]
Abstract
Objective This narrative review analyses factors affecting recurrence of Chronic rhinosinusitis with nasal polyps (CRSwNP) after surgery, such as type, extension and completeness of endoscopic sinus surgery (ESS). We also described new implications in the management of recurrences after the advent of biologics. Methods We identified four topics: definition of disease state; factors linked to recurrence of polyps; evaluation and management of recurrence in clinical practice. Results We analysed the differences between exacerbation and recurrence, as well as the concept of "controlled disease". We focused on potential predictors of recurrence after ESS, such as type 2 inflammation, asthma, aspirin-exacerbated respiratory disease, incomplete initial surgery and lack of adherence to long-term post-operative local corticosteroids. We discussed the new aspects of diagnosis and treatment of recurrences after surgery, summarising our suggestions in a detailed algorithm for practical management of patients with recurrent disease. Conclusions The results emphasised the importance of accurate evaluation of patients with CRSwNP recurrence, focusing on the reasons of failure and risk of disease progression, in order to guide personalised interventions. It is crucial to define the concept of appropriate surgery, which affects the choice between starting a biologic or repeating surgery.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
| | - Stefano Settimi
- Unit of Otorhinolaryngology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
- Department of Head, Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | - Claudio Montuori
- Department of Head, Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandro Cantiani
- Department of Head, Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | - Marco Corbò
- Department of Head, Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | | | - Fabio Sovardi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mario Rigante
- Unit of Otorhinolaryngology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
| | - Giulio Cesare Passali
- Unit of Otorhinolaryngology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
- Department of Head, Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Unit of Otorhinolaryngology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
| | - Jacopo Galli
- Unit of Otorhinolaryngology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
- Department of Head, Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy
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Pelaia C, Benfante A, Busceti MT, Caiaffa MF, Campisi R, Carpagnano GE, Crimi N, D’Amato M, Foschino Barbaro MP, Maglio A, Minenna E, Nolasco S, Paglino G, Papia F, Pelaia G, Portacci A, Ricciardi L, Scichilone N, Scioscia G, Triggiani M, Valenti G, Vatrella A, Crimi C. Real-life effects of dupilumab in patients with severe type 2 asthma, according to atopic trait and presence of chronic rhinosinusitis with nasal polyps. Front Immunol 2023; 14:1121237. [PMID: 37063895 PMCID: PMC10098307 DOI: 10.3389/fimmu.2023.1121237] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BackgroundThe efficacy of dupilumab as biological treatment of severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) depends on its ability to inhibit the pathophysiologic mechanisms involved in type 2 inflammation.ObjectiveTo assess in a large sample of subjects with severe asthma, the therapeutic impact of dupilumab in real-life, with regard to positive or negative skin prick test (SPT) and CRSwNP presence or absence.MethodsClinical, functional, and laboratory parameters were measured at baseline and 24 weeks after the first dupilumab administration. Moreover, a comparative evaluation was carried out in relation to the presence or absence of SPT positivity and CRSwNP.ResultsAmong the 127 recruited patients with severe asthma, 90 had positive SPT, while 78 reported CRSwNP. Compared with the 6 months preceding the first dupilumab injection, asthma exacerbations decreased from 4.0 (2.0-5.0) to 0.0 (0.0-0.0) (p < 0.0001), as well as the daily prednisone intake fell from 12.50 mg (0.00-25.00) to 0.00 mg (0.00-0.00) (p < 0.0001). In the same period, asthma control test (ACT) score increased from 14 (10-18) to 22 (20-24) (p < 0.0001), and sino-nasal outcome test (SNOT-22) score dropped from 55.84 ± 20.32 to 19.76 ± 12.76 (p < 0.0001). Moreover, we observed relevant increases in forced expiratory volume in one second (FEV1) from the baseline value of 2.13 L (1.62-2.81) to 2.39 L (1.89-3.06) (p < 0.0001). Fractional exhaled nitric oxide (FeNO) values decreased from 27.0 ppb (18.0-37.5) to 13.0 ppb (5.0-20.0) (p < 0.0001). These improvements were quite similar in subgroups of patients characterized by SPT negativity or positivity, and CRSwNP absence or presence. No statistically significant correlations were detected between serum IgE levels, baseline blood eosinophils or FeNO levels and dupilumab-induced changes, with the exception of FEV1 increase, which was shown to be positively correlated with FeNO values (r = 0.3147; p < 0.01).ConclusionOur results consolidate the strategic position of dupilumab in its role as an excellent therapeutic option currently available within the context of modern biological treatments of severe asthma and CRSwNP, frequently driven by type 2 airway inflammation.
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Affiliation(s)
- Corrado Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- *Correspondence: Corrado Pelaia,
| | - Alida Benfante
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Maria Teresa Busceti
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | | | - Raffaele Campisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Maria D’Amato
- Department of Respiratory Medicine, University “Federico II” of Naples, Naples, Italy
| | | | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Elena Minenna
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe Paglino
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Francesco Papia
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Andrea Portacci
- Department of Basic Medical Science, Neuroscience and Sense Organs, University “Aldo Moro”, Bari, Italy
| | - Luisa Ricciardi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Nicola Scichilone
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Massimo Triggiani
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Grose E, Li AY, Lee JM. Clinical outcomes of dupilumab therapy in chronic rhinosinusitis with nasal polyps in a Canadian tertiary care rhinology practice. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:26. [PMID: 36998065 DOI: 10.1186/s13223-023-00782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/27/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND In 2020, dupilumab became the first monoclonal antibody therapy to be approved by Health Canada for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). The primary aim of this study was to characterize the outcomes in an initial cohort of patients with CRSwNP who have undergone dupilumab therapy. METHODS A retrospective study was conducted of patients with CRSwNP who were treated with dupilumab. Demographic information, comorbidities, number of previous surgeries, and insurance information were collected. The primary outcome were changes in the sinonasal outcome test (SNOT-22) scores from baseline to timepoints after receiving dupilumab. RESULTS Forty-eight patients were considered for dupilumab therapy, and 27 (56%) received coverage or were able to fund the medication independently. Patients waited an average of 3.6 months to obtain access to the medication. The mean age of the patients was 43. Forty-one percent (11/27) of patients had aspirin exacerbated respiratory disease, and 96% (26/27) had a diagnosis of asthma. The mean length of time on dupilumab was 12.1 months. The baseline SNOT-22 score was 60.6. The mean decrease at 1 month, 3 months, 6 months, and 12 months after starting dupilumab was 8.8, 26.5, 42.8, and 33.8, respectively. There were no serious adverse events. CONCLUSION Patients treated with dupilumab in a Canadian tertiary care rhinology clinic demonstrated substantial clinical improvement as measured by disease-specific sinonasal outcomes. Further studies are needed to determine the longer-term effectiveness and adverse event profile of this novel therapy.
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Affiliation(s)
- Elysia Grose
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, USA.
| | - Alyssa Y Li
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, USA
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, USA.
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Ottaviano G, De Corso E, Cantone E, Ciofalo A, Saccardo T, Bernardi R, Mairani E, Montuori C, Roccuzzo G, Soldati L, Randon B, Zampollo S, Chicco AD, Visconti F, Scarpa B, Nicolai P. Measuring Nasal Patency and the Sense of Smell in CRSwNP Patients Treated with Dupilumab. J Pers Med 2023; 13:jpm13020234. [PMID: 36836468 PMCID: PMC9962970 DOI: 10.3390/jpm13020234] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) in the most severe forms is associated with a poor quality of life. Dupilumab has been suggested as an add-on treatment option for severe CRSwNP. Severe CRSwNP patients treated with dupilumab in different rhinological units were followed up at 1, 3, 6 and 12 months from the first administration and were considered for this study. At baseline (T0) and at each follow-up, patients underwent nasal endoscopy and completed the sinonasal outcome test (SNOT)-22, a visual analogue scale (VAS) for smell/nasal obstruction, peak nasal inspiratory flow (PNIF) and the Sniffin' Sticks identification test (SSIT). The aim of the present study was to evaluate the effects of dupilumab in patients with severe uncontrolled CRSwNP on recovering nasal obstruction and smell impairment. Moreover, the method between PNIF and SSIT with the highest correlation with patients' response to dupilumab was evaluated. One hundred forty-seven patients were included. All parameters improved during treatment (p < 0.001). At T0, no correlations were found between PNIF and nasal symptoms. Nevertheless, during the following evaluations significant correlations between PNIF changes and both nasal symptoms and NPS were observed (p < 0.05). At T0, SSIT did not correlate with SNOT-22. Similarly to PNIF, during the follow-up SSIT changes significantly correlated with nasal symptom and NPS (p < 0.05). Comparing PNIF and SSIT correlations with SNOT-22 and NPS, PNIF showed a higher correlation with both. Dupilumab improves nasal obstruction and the sense of smell. PNIF and SSIT are effective tools in monitoring patients' response to dupilumab.
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Affiliation(s)
- Giancarlo Ottaviano
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-(0)-49-8214470; Fax: +39-(0)-49-8213113
| | - Eugenio De Corso
- ENT Department of A. Gemelli Unversitary Hospital IRCCS, 00168 Rome, Italy
| | - Elena Cantone
- Reproductive and Odontostomatological Sciences-ENT Section, Department of Neuroscience, University of Naples Federico II, 80131 Naples, Italy
| | - Andrea Ciofalo
- Rhinology Unit, Department of Sensory Organs, Sapienza University of Rome, 00161 Rome, Italy
| | - Tommaso Saccardo
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, 35128 Padova, Italy
| | - Riccardo Bernardi
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, 35128 Padova, Italy
| | - Edoardo Mairani
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, 35128 Padova, Italy
| | - Claudio Montuori
- ENT Department of A. Gemelli Unversitary Hospital IRCCS, 00168 Rome, Italy
| | - Giuseppe Roccuzzo
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, 35128 Padova, Italy
| | - Livia Soldati
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, 35128 Padova, Italy
| | - Benedetto Randon
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, 35128 Padova, Italy
| | - Sonny Zampollo
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, 35128 Padova, Italy
| | - Alessandra Di Chicco
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, 35128 Padova, Italy
| | - Francesca Visconti
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, 35128 Padova, Italy
| | - Bruno Scarpa
- Department of Statistical Sciences, University of Padova, 35100 Padova, Italy
| | - Piero Nicolai
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, 35128 Padova, Italy
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Lepley TJ, Wu Z, Root Z, Mountain D, Otto BA, Kelly K, Zhao K. Computational fluid dynamic modeling of the effect of dupilumab in the management of anosmia secondary to chronic rhinosinusitis with nasal polyps (CRSwNP). Int Forum Allergy Rhinol 2022; 12:1578-1580. [PMID: 35765860 PMCID: PMC10162444 DOI: 10.1002/alr.23050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Thomas J. Lepley
- Department of Otolaryngology–Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Zhenxing Wu
- Department of Otolaryngology–Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Zach Root
- Department of Otolaryngology–Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Drew Mountain
- Department of Otolaryngology–Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Bradley A. Otto
- Department of Otolaryngology–Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Kathleen Kelly
- Department of Otolaryngology–Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Kai Zhao
- Department of Otolaryngology–Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
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Trimarchi M, Vinciguerra A, Rampi A, Tanzini U, Nonis A, Yacoub MR, Bussi M. A prospective study on the efficacy of dupilumab in chronic rhinosinusitis with type 2 inflammation. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:538-544. [PMID: 36654520 PMCID: PMC9853107 DOI: 10.14639/0392-100x-n2156] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/16/2022] [Indexed: 01/18/2023]
Abstract
Objective Treatment for chronic rhinosinusitis with nasal polyps (CRSwNP) includes endoscopic sinus surgery and topic and/or systemic corticosteroids, which have only temporary effects. The development of biologic therapies has provided a new treatment paradigm for CRSwNP. Dupilumab is the only biological approved in Italy for CRSwNP, but its efficacy in a real-life context is still scarce. Methods We carried out a monocentric prospective study at our institution with a 6-month follow-up on patients administered biweekly 300 mg dupilumab therapy for CRSwNP, prescribed according to EPOS 2020 criteria. Patients were evaluated at baseline and every 2 months. Results Median values at baseline and 6 months were, respectively, 3/12 and 8/12 for the Brief Smell Identification Test (p = 0.005), 5/8 and 2/8 for the Nasal Polyp Score (p < 0.001), 10/20 and 6/20 for the Lund-Kennedy score (p < 0.001), 65/110 and 14/110 for the Sinonasal Outcome Test (p < 0.001), and 15/25 and 23/25 for the Asthma Control Test score (p = 0.009). Adverse events were mild, consisting mainly in discomfort at the site of injection. Four patients developed asymptomatic hypereosinophilia. The treatment was not discontinued in any patient. Conclusions Dupilumab was confirmed to be an effective and safe treatment for CRSwNP, as previously seen in registrational studies.
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Affiliation(s)
- Matteo Trimarchi
- Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy, School of Medicine, Vita-Salute San Raffaele University, Milan, Italy,Correspondence Matteo Trimarchi Otolaryngology Department, San Raffaele Hospital, via Olgettina 68, 20132 Milan, Italy Tel. +39 02 26438442 E-mail:
| | | | - Andrea Rampi
- Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy, School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Umberto Tanzini
- Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy, School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Nonis
- CUSSB, University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Mona Rita Yacoub
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy, Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy, School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Torretta S, De Corso E, Nava N, Fraccaroli F, Ferrucci SM, Settimi S, Montuori C, Porru DP, Spanu C, D’Agostino G, Marzano AV, Pignataro L. Proposal for a Structured Outpatient Clinic for Dupilumab Treatment in Chronic Rhinosinusitis with Nasal Polyps in the First Year of Treatment. J Pers Med 2022; 12:jpm12101734. [PMID: 36294873 PMCID: PMC9605368 DOI: 10.3390/jpm12101734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 11/30/2022] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common disease of the nose and paranasal sinuses with important economic and sanitary burdens, as well as having a great impact on patients’ quality of life. In this field, a new therapeutic approach for those patients who have been described as affected by severe uncontrolled CRSwNP, resistant to medical and best surgical treatment, is represented by subcutaneous human monoclonal antibodies (including dupilumab) that block specific targets involved in the type 2 inflammatory pathway which most commonly drives CRSwNP pathophysiology. This paper aims to report our experience in the management of severe uncontrolled CRSwNP and, in particular, describe our diagnostic workup including baseline evaluation and follow-up visits in the first year of treatment. We also describe into detail our multidisciplinary approach to the disease. We finally report the outcomes of treatment in a real-life setting. In this outpatient real-life setting, our results confirmed the effectiveness of dupilumab in reducing the volume of nasal polyps and restoring nasal obstruction and sense of smell, as well as improving patients’ quality of life. The adherence to the dupilumab treatment was very high. The dose of administration was never modified in patients in the first year of treatment. All the patients respected the plan of the visits at proposed time points. We believe that the structural organization of our outpatient clinic appears to be functional: it allows us to study patients thoroughly before starting treatment and to make a proper follow-up after it starts. We believe that sharing both our strict clinical flowchart and growing experience with dupilumab with the medical community can lead to more standardized and effective pathways of care for CRSwNP patients.
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Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Center of Excellence of Type 2 Inflammation, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
- Correspondence:
| | - Eugenio De Corso
- Unit of Otorhinolaryngology-Head and Neck Surgery, “A. Gemelli” Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Nicolò Nava
- Faculty of medicine, Università degli Studi di Milano, 20122 Milan, Italy
| | - Francesca Fraccaroli
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Center of Excellence of Type 2 Inflammation, 20122 Milan, Italy
| | - Silvia Mariel Ferrucci
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Center of Excellence of Type 2 Inflammation, 20122 Milan, Italy
| | - Stefano Settimi
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Claudio Montuori
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Davide Paolo Porru
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Camilla Spanu
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Giuseppe D’Agostino
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Angelo Valerio Marzano
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Center of Excellence of Type 2 Inflammation, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Center of Excellence of Type 2 Inflammation, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
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Ottaviano G, Saccardo T, Roccuzzo G, Bernardi R, Chicco AD, Pendolino AL, Scarpa B, Mairani E, Nicolai P. Effectiveness of Dupilumab in the Treatment of Patients with Uncontrolled Severe CRSwNP: A "Real-Life" Observational Study in Naïve and Post-Surgical Patients. J Pers Med 2022; 12:jpm12091526. [PMID: 36143311 PMCID: PMC9502990 DOI: 10.3390/jpm12091526] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) represents 25−30% of all CRS cases, and in the most severe forms it is associated with a poor quality of life and a high rate of nasal polyps’ recurrence after surgery. Dupilumab has been suggested as a treatment option for severe CRSwNP. Methods: Patients with severe CRSwNP receiving dupilumab from January 2021 were followed up at 1, 3, 6, 9 and 12 months from the first administration and were considered for this study. At baseline and at each follow-up, patients underwent nasal endoscopy and completed the Sinonasal Outcome Test (SNOT)-22, a Visual Analogue Scale (VAS) for smell/nasal obstruction, the Nasal Congestion Score and the Asthma Control Test. Peak nasal inspiratory flow (PNIF), a smell test, nasal cytology and blood eosinophilia were also evaluated. Results: Forty-seven patients were included in the study. Of these, 33 patients had a history of previous surgery (ESS) and had recurrent nasal polyps, while 14 patients were naïve to nasal surgery. Both subjective and objective parameters improved after biological treatment and were correlated with each other (p < 0.05), except for the SNOT-22 and the nasal polyp’s score. No correlations were found between nasal and blood eosinophilia. No differences were observed when comparing the post-surgical and the naïve groups. Conclusions: Dupilumab improves nasal obstruction and the sense of smell and reduces the level of local inflammation in severe CRSwNP patients in a similar way in both naïve and post-surgical patients.
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Affiliation(s)
- Giancarlo Ottaviano
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-(0)49-8214470; Fax: +39-(0)49-8213113
| | - Tommaso Saccardo
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Giuseppe Roccuzzo
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Riccardo Bernardi
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Alessandra Di Chicco
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Alfonso Luca Pendolino
- Department of ENT, Royal National ENT and Eastman Dental Hospitals, London WC1E 6DG, UK
- Ear Institute, University College London, London WC1X 8EE, UK
| | - Bruno Scarpa
- Department of Statistical Sciences and Department of Mathematics Tullio Levi-Civita, University of Padova, 35128 Padova, Italy
| | - Edoardo Mairani
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Piero Nicolai
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
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De Corso E, Baroni S, Settimi S, Onori ME, Mastrapasqua RF, Troiani E, Moretti G, Lucchetti D, Corbò M, Montuori C, Cantiani A, Porru DP, Lo Verde S, Di Bella GA, Caruso C, Galli J. Sinonasal Biomarkers Defining Type 2-High and Type 2-Low Inflammation in Chronic Rhinosinusitis with Nasal Polyps. J Pers Med 2022; 12:jpm12081251. [PMID: 36013200 PMCID: PMC9410079 DOI: 10.3390/jpm12081251] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
The complex pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwNP) generates a spectrum of phenotypes with a wide variety of inflammatory states. We enrolled 44 very-likely-to-be type 2 CRSwNP patients in order to evaluate the load of inflammation and to analyze human interleukins in nasal secretion. Clinical data were collected to evaluate the severity of the disease. High levels of IL-5, IL-4, IL-6, and IL-33 were detected in all type 2 CRSwNP patients. By analyzing type 2 cytokine profiles and local eosinophil count, we identified two coherent clusters: the first was characterized by high levels of IL-4, IL-5, IL-6, and a high-grade eosinophil count (type 2-high); the second had lower levels of cytokines and poor or absent eosinophilic inflammation (type-2 low). IL-5 levels were significantly higher within the type 2 cytokine and it was the most reliable biomarker for differentiating the two clusters. In type 2-high inflammatory profile clinical scores, the mean number of previous surgeries and need for systemic corticosteroids were significantly higher compared to type 2-low. Our research demonstrated the potential role of type 2 biomarkers, and in particular, of IL-5 in identifying patients with a more severe phenotype based on a high inflammatory load.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy; (E.D.C.); (J.G.)
| | - Silvia Baroni
- Unit of Chemistry, Biochemistry and Molecular Biology, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy;
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Stefano Settimi
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy; (E.D.C.); (J.G.)
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
- Correspondence: ; Tel.: +39-0630154439
| | - Maria Elisabetta Onori
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Rodolfo Francesco Mastrapasqua
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Eliana Troiani
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Giacomo Moretti
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Donatella Lucchetti
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Marco Corbò
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Claudio Montuori
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Alessandro Cantiani
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Davide Paolo Porru
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Simone Lo Verde
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Giuseppe Alberto Di Bella
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Cristiano Caruso
- Department of Medical and Surgical Sciences, Digestive Disease Center, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Jacopo Galli
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy; (E.D.C.); (J.G.)
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
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Olfaction Recovery following Dupilumab Is Independent of Nasal Polyp Reduction in CRSwNP. J Pers Med 2022; 12:jpm12081215. [PMID: 35893310 PMCID: PMC9330729 DOI: 10.3390/jpm12081215] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic type 2 inflammatory disease characterized by olfactory impairment (OI) as one of the most troublesome symptoms. Currently, biologics represent a new option in the treatment of uncontrolled type 2 CRSwNP. This is a retrospective real-life observational study involving adult patients affected by severe uncontrolled CRSwNP. At baseline, and 3 and 6 months after Dupilumab add on to intranasal steroids (INS), patients underwent the 22-item Sinonasal Outcome Test (SNOT-22), nasal endoscopy, Visual Analogue Scale (VAS) scale for OI, and Sniffin Sticks-16 items identification test (SS-I). We observed improvement in all clinical outcomes with a significant correlation between VAS-SS-I/SNOT22, whereas we did not find a correlation between Nasal Polyp Score (NPS) and SS-I or VAS. Interestingly, patients reported a higher degree of improvement of OI on the VAS than on the SS-I. These data demonstrate that the patients were not aware about the degree of their OI and the perception of general improvement in their health-related quality of life (HRQoL) may have influenced the VAS score. Moreover, we observed a lack of correlation between NPS and SS-I or VAS, suggesting that OI did not depend on the polyps’ volume and may be due mainly to the resolution of inflammation. So, the physiopathological mechanisms underlying OI in CRSwNP and its recovery after Dupilumab might be unrelated to the volume of the polyps and might depend mainly on the anti-inflammatory effects. Future studies including biomarkers may be useful to clarify this aspect.
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