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Domínguez-Sosa MS, Cabrera-Ramírez MS, Marrero-Ramos MDC, Dávila-Quintana D, Cabrera-López C, González Cuervo H, Benítez Del Rosario JJ, Carrillo-Díaz T. Efficacy of dupilumab on chronic rhinosinusitis with nasal polyps and concomitant asthma in biologic-naive and biologic-pretreated patients. Ann Med 2024; 56:2411018. [PMID: 39364704 DOI: 10.1080/07853890.2024.2411018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/14/2024] [Accepted: 05/28/2024] [Indexed: 10/05/2024] Open
Abstract
OBJECTIVES Dupilumab, an anti-IL-4 receptor monoclonal antibody (mAb), was recently approved for the treatment of severe chronic rhinosinusitis with nasal polyps (CRSwNP). The main objective of this study was to assess whether previous exposure to biological treatment affected the clinical outcomes in CRSwNP and asthma patients, treated with dupilumab over time. A collateral secondary objective was to analyse the effects over time of dupilumab in patients with and without aeroallergen sensitization. METHODS Single-centre retrospective observational study on severe CRSwNP patients treated with dupilumab. Nasal polyp score (NPS), visual analogue scale (VAS) symptom score, sinonasal outcome test (SNOT-22), aeroallergen sensitization, total serum IgE levels, and blood eosinophil counts were assessed at baseline and after 4, 6 and 12 months. RESULTS 42 patients were included, 40 (95.2%) had asthma. Twenty-one (50%) patients received dupilumab without prior biological treatment (Group A: naive) and 50% switched to dupilumab from previous biological treatment (Group B: pre-treated). NPS, VAS symptoms, SNOT-22 improved significantly after 12 months treatment in both groups of patients (p < 0.001). After 12 months, VAS overall symptom score showed a significant reduction from 6 (IQR, 4.6-8.6) and 6 (IQR, 3.8-7.1) for Group A and Group B patients respectively, to 1.2 (IQR, 0.8-2.7) and 1.2 (IQR, 0.2-2.5); NPS from 6 (IQR, 4.0-7.0) and 5 (IQR, 3.5-6.0), respectively, to 1 (IQR, 0.0-2.0) and 0 (IQR, 0.0-3.0) and SNOT-22 from 64 (IQR, 56-78) and 71 (IQR, 47.5-76.0) respectively, to 5.5 (IQR, 4-21) and 6 (IQR, 4-15). IgE reduced from 57 to 22.1 and from 46.9 to 30.2 in Group A and Group B respectively (p < 0.001). CONCLUSIONS Dupilumab improves symptom severity, polyp size, and health-related quality of life, regardless of the presence or absence of comorbid aeroallergen sensitization and previous administration of biologic therapy.
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Affiliation(s)
- María Sandra Domínguez-Sosa
- Department of Otorhinolaryngology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - María Soledad Cabrera-Ramírez
- Department of Otorhinolaryngology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Delia Dávila-Quintana
- Department of Quantitative Methods in Economics and Management, Universidad de las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Carlos Cabrera-López
- Department of Pneumology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Heleia González Cuervo
- Department of Allergology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Teresa Carrillo-Díaz
- Department of Medical and Surgical Science, Universidad de las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Tajiri T, Suzuki M, Nishiyama H, Ozawa Y, Kurokawa R, Ito K, Fukumitsu K, Mori Y, Kanemitsu Y, Fukuda S, Uemura T, Ohkubo H, Takemura M, Maeno K, Ito Y, Oguri T, Iwasaki S, Niimi A. Efficacy of dupilumab for severe chronic rhinosinusitis with nasal polyps and asthma: A prospective study. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00422-8. [PMID: 38972450 DOI: 10.1016/j.anai.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Dupilumab exerts clinical effects, including improved sinus opacification, olfactory function, and quality of life, in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNPs). Meanwhile, only a few studies have reported its effects on nasal airway resistance and olfactory function, particularly in the Japanese population. Predictors of response remain unclear. OBJECTIVE To assess the comprehensive efficacy and therapeutic response to dupilumab in patients with severe CRSwNP with comorbid asthma. METHODS In 16 adult patients with severe CRSwNP with comorbid asthma, the efficacy of 48-week dupilumab treatment, including olfactory function measured by a T&T olfactometer, nasal airway resistance measured by rhinomanometry, nasal polyp score, Lund-Mackay computed tomography score, and 22-item Sinonasal Outcome Test (SNOT-22), was assessed. Regarding asthma, the annualized rate of exacerbations, 7-item Asthma Control Questionnaire (ACQ-7), and spirometry were assessed. Treatment responsiveness was analyzed. RESULTS With 48-week dupilumab treatment, olfactory function, nasal airway resistance, nasal polyp score, Lund-Mackay computed tomography score, and SNOT-22 scores improved significantly. Regarding comorbid asthma, the annualized rate of exacerbations decreased, and ACQ-7 scores and lung function improved significantly. According to the European Position Paper on Rhinosinusitis and Nasal Polyps 2020/European Forum for Research and Education in Allergy and Airway Diseases criteria, 15 patients (94%) were moderate-to-excellent responders at 48 weeks of treatment. Patients with higher SNOT-22 scores, ACQ-7 scores, the rate of asthma exacerbations in the previous year, and blood eosinophil counts benefited more from the treatment. CONCLUSION Dupilumab improved upper and lower airway outcomes especially in patients with severe CRSwNP with comorbid, poorly controlled asthma. TRIAL REGISTRATION UMIN Clinical Trials Registry: UMIN000038669.
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Affiliation(s)
- Tomoko Tajiri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan.
| | - Motohiko Suzuki
- Department of Otorhinolaryngology & Head and Neck Surgery, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Hirono Nishiyama
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Yoshiyuki Ozawa
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Aichi, Japan
| | - Ryota Kurokawa
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Keima Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Kensuke Fukumitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Yuta Mori
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Yoshihiro Kanemitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Satoshi Fukuda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Takehiro Uemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Hirotsugu Ohkubo
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Masaya Takemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Ken Maeno
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Yutaka Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Tetsuya Oguri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Shinichi Iwasaki
- Department of Otorhinolaryngology & Head and Neck Surgery, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
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Dorling M, Hernaiz-Leonardo JC, Pascual A, Janjua A, Thamboo A, Javer A. Real-World Adverse Events After Type 2 Biologic use in Chronic Rhinosinusitis with Nasal Polyps. Laryngoscope 2024; 134:3054-3059. [PMID: 38314858 DOI: 10.1002/lary.31305] [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: 10/06/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To investigate the frequency and nature of adverse events related to type 2 biologic use in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), including dupilumab and mepolizumab. METHODS This is a single-institution retrospective study of real-world patient data. Patients were included if they have a diagnosis of CRSwNP, have undergone at least one endoscopic sinus surgery, and have taken at least two doses of dupilumab or mepolizumab between January 1, 2016, and July 1, 2023. Data collected include clinicodemographic information and past medical/surgical history. The primary outcomes are the incidence and types of adverse events. Adjusted odds ratio was calculated to compare the biologics using logistic regression. Risk factors for developing adverse events were investigated. RESULTS Eighty-seven patients on dupilumab and 51 patients on mepolizumab were included. Thirty-nine (45%) and 10 (20%) patients respectively encountered adverse events, which differed from phase 3 trial data. The adjusted odds ratio for adverse event rates between these two treatment groups was 3.8 (95% CI, 1.5-10.5). The most common adverse events for dupilumab were arthralgia (16%), rash (14%), and conjunctivitis or xerophthalmia (10%). The main adverse events for mepolizumab were headache (6%) and fatigue (6%). Seven dupilumab and three mepolizumab patients discontinued therapy due to adverse events. The average duration of treatment was 22.5 (range: 1-77) months for mepolizumab and 15.9 (range: 1-35) months for dupilumab. CONCLUSION Dupilumab and mepolizumab have distinct adverse event profiles. This study contributes to informing clinicians' decisions regarding the use of type 2 biologics in CRSwNP patients. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3054-3059, 2024.
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Affiliation(s)
- Marisa Dorling
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Juan C Hernaiz-Leonardo
- Department of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Athenea Pascual
- Department of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arif Janjua
- Department of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Thamboo
- Department of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amin Javer
- Department of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Galletti C, Ciodaro F, Barbieri MA, Gambino F, Ferrisi MG, Portelli D, Catalano N, Spina E, Freni F, Galletti B. Effectiveness and safety profile of mepolizumab in chronic rhinosinusitis with nasal polyps: Real life data in a tertiary care. Am J Otolaryngol 2024; 45:104329. [PMID: 38696895 DOI: 10.1016/j.amjoto.2024.104329] [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: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by a type 2 pattern of inflammation. Mepolizumab was approved for the treatment of CRSwNP in 2021, it may be useful to evaluate its safety profile in a real-world setting. AIM This work aimed to prospectively highlight the effectiveness and safety profile of Mepolizumab in patients with CRSwNP enrolled in the Otorhinolaryngology Unit of the University Hospital of Messina. METHODS An observational cohort study was carried out considering all patients treated with Mepolizumab. A descriptive analysis was conducted reporting all demographic characteristics, endoscopic evaluations, and symptom conditions. RESULTS A total of 30 patients were treated with Mepolizumab, one patient discontinued the treatment. A statistically significant reduction in the Sino-Nasal Outcome Tests-22 (SNOT-22) and nasal polyp score (NPS) was shown at the 6th and 12th months compared to baseline values (SNOT-22, -33 and - 43, p < 0.001 for both comparisons; NPS, 0 and - 1, p < 0.001 for both comparisons). The median (Q1-Q3) sniffin' sticks test score increased from 7 (6-8) at the 6th month to 11 (10-13) at the 12th month. Seven patients (24.1 %) reported pain at the injection site, accompanied by redness, warmth, and tenderness within the first 24 h post-injection with a median duration of three days from the onset. CONCLUSIONS Given the optimal treatment response and the minimal adverse effects observed, clinicians should consider Mepolizumab a safe and effective treatment in CRSwNP patients. Further studies in real-life setting are necessary to better understand the long-term effects.
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Affiliation(s)
- Cosimo Galletti
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy.
| | - Francesco Ciodaro
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy
| | | | - Fabiana Gambino
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy
| | - Maria Grazia Ferrisi
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy
| | - Daniele Portelli
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy
| | - Natalia Catalano
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Freni
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy
| | - Bruno Galletti
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy
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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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Ottaviano G, Roccuzzo G, Lora L, Bison E, Tosin E, Calvanese L, Cestaro W, Locatello LG, Corlianò F, Stellin M, Baldovin M, Trimarchi MV, Bertocco AG, Maculan M, Scarpa B, Saccardo T, Nicolai P. The Impact of Dupilumab on Work Productivity and Emotional Health in CRSwNP: A Multicentric Study in Northeast Italy. J Pers Med 2024; 14:468. [PMID: 38793051 PMCID: PMC11121907 DOI: 10.3390/jpm14050468] [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: 04/01/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) in the 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 considered for this study via their evaluation at the baseline at first and the consequential follow-up at 6-, 12-, and 24 months from the first administration. At baseline (T0) and at each follow-up, patients underwent NPS, Sinonasal Outcome Test (SNOT)-22, Visual Analogue Scale (VAS) for smell, and Sniffin' sticks identification test (SSIT). The SNOT-22 domains for function and emotion were also analysed separately. Two hundred and seventeen patients with at least 6 months of follow-up were included. All parameters have improved during treatment (p < 0.0001). Noticeably, both the function and emotion SNOT-22 domains have improved within 6 months of treatment and have continued to progress during every interval within 12 months from the baseline, positively influencing patients' emotivity and augmenting their social and economic performances. Dupilumab improves the QoL of CRSwNP patients with good effects on the reported productivity and emotional health. Clinicians should pay attention to these two aspects when dealing with patients affected by severe CRSwNP.
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Affiliation(s)
- Giancarlo Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (G.R.)
| | - Giuseppe Roccuzzo
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (G.R.)
| | - Lucia Lora
- ENT Department, Ospedale dell’Angelo, ULSS 3 Serenissima, Mestre, 30174 Venezia, Italy
| | | | - Enrico Tosin
- ENT Department, Hospital of Rovigo, 45100 Rovigo, Italy
| | - Leonardo Calvanese
- ENT Unit, Department of Surgery, Ospedali Riuniti Padova Sud, 35043 Monselice, Italy
| | - Walter Cestaro
- ENT Consultant, Head and Neck Department, ULSS 2 Marca Trevigiana, 31100 Treviso, Italy;
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, University Hospital “Santa Maria Della Misericordia”, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy;
| | - Fabrizio Corlianò
- Department of Otolaryngology Head and Neck Surgery, San Bassiano Hospital, Via Dei Lotti 40, 36061 Bassano Del Grappa, Italy
| | - Marco Stellin
- Department of Neurosciences, Section of Otolaryngology, University of Padova, 31100 Treviso, Italy;
| | - Maria Baldovin
- ENT Unit, Ospedale San Martino, Belluno, ULSS1 Dolomiti, 32100 Belluno, Italy
| | | | - Anna Giulia Bertocco
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (G.R.)
| | - Marco Maculan
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (G.R.)
| | - Bruno Scarpa
- Department of Statistical Sciences, University of Padova, 35122 Padova, Italy;
| | - Tommaso Saccardo
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (G.R.)
| | - Piero Nicolai
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (G.R.)
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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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La Mantia I, Ottaviano G, Ragusa M, Trimarchi M, Foglia E, Schettini F, Bellavia D, Cantone E. Multidimensional Impact of Dupilumab on Chronic Rhinosinusitis with Nasal Polyps: A Complete Health Technology Assessment of Clinical, Economic, and Non-Clinical Domains. J Pers Med 2024; 14:347. [PMID: 38672974 PMCID: PMC11051702 DOI: 10.3390/jpm14040347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
Chronic RhinoSinusitis with Nasal Polyps (CRSwNP) represents a condition mainly caused by the type 2 inflammation presence and marked by the existence of polyps within the nasal and paranasal sinuses. The standard of care includes intranasal steroids, additional burst of systemic steroids, if needed, and surgery. However, recurrence is common, especially among patients with comorbid type 2 inflammatory diseases. Recently, biological drugs, addressing the underlying cause of the disease, have been approved in Italy (dupilumab, omalizumab, and mepolizumab). A Health Technology Assessment was conducted to define multidimensional impact, assuming Italian NHS perspective and a 12-month time horizon. The EUnetHTA Core Model was deployed, using the following methods to analyze the domains: (i) literature evidence; (ii) administration of semi-structured questionnaires to 17 healthcare professionals; (iii) health economics tools to define the economic sustainability for the system. Evidence from NMA and ITC showed a more favorable safety profile and better efficacy for dupilumab compared with alternative biologics. All the analyses, synthesizing cost and efficacy measures, showed that dupilumab is the preferable alternative. Specifically, the cost per responder analysis for dupilumab, exhibiting a 67.0% response rate at Week 52, is notably economical at 14,209EUR per responder. This presents a more economical profile compared with the cost per responder for omalizumab (36.2% response rate) at 24,999EUR and mepolizumab (28.5% response rate) at 31,863EUR. These results underscore dupilumab's potential, not merely in terms of clinical outcomes, but also in terms of economic rationality, thereby solidifying its status as a valid and preferrable alternative in the management of CRSwNP, in the context of the Italian NHS.
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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, 95100 Catania, Italy
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35122 Padova, Italy
| | - Martina Ragusa
- Operative Unit of Otolaryngology, ASP Messina, Taormina Hospital (ME), 98039 Taormina, Italy
| | - Matteo Trimarchi
- Faculty of Biomedical Sciences and Lugano Regional Hospital, University of Italian Switzerland, 6900 Lugano, Switzerland
| | - Emanuela Foglia
- Healthcare Datascience LAB, LIUC—Carlo Cattaneo University, 21053 Castellanza, Italy
| | - Fabrizio Schettini
- Healthcare Datascience LAB, LIUC—Carlo Cattaneo University, 21053 Castellanza, Italy
| | - Daniele Bellavia
- Healthcare Datascience LAB, LIUC—Carlo Cattaneo University, 21053 Castellanza, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, University of Naples 29 Federico II, 80131 Naples, Italy
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9
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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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10
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Norelli F, Schiappoli M, Senna G, Pinter P, Olivieri B, Ottaviano G, De Corso E, Caminati M. Adherence to Intranasal Steroids in Chronic Rhinosinusitis with Nasal Polyposis Prior to and during Biologic Therapy: A Neglected Matter. J Clin Med 2024; 13:1066. [PMID: 38398379 PMCID: PMC10889709 DOI: 10.3390/jcm13041066] [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: 12/15/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Adherence to treatment is essential in chronic rhinosinusitis with nasal polyposis (CRSwNP). Intranasal corticosteroids (INCS) are the first-line therapy, followed by systemic corticosteroids and surgery if needed. In cases of refractory disease, biologics are added to conventional treatment, making adherence to INCS crucial in assessing eligibility for these targeted therapies. The purpose of this review is to examine INCS adherence assessment and rate, before starting and during biologic therapy. We conducted a comprehensive literature review focusing on INCS adherence in CRSwNP treated with biologics, including randomized controlled trials and real-life studies. The search extended to studies on allergic and non-allergic rhinitis to provide broader insights into tools to assess the INCS adherence. The result was that adherence to INCS in CRSwNP is underexplored, with only a few studies addressing it directly. Various tools for adherence assessment have been identified, but none are universally accepted as standard. The review also highlights the complexity of factors influencing adherence rates. Effective CRSwNP management requires a paradigm shift to prioritize adherence in treatment guidelines and clinical practice. The review advocates for improved adherence assessment tools, a deeper understanding of influencing factors, and the integration of personalized medicine approaches, especially for biologic therapies.
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Affiliation(s)
- Francesca Norelli
- Department of Medicine, University of Verona, 37129 Verona, Italy; (F.N.); (G.S.)
| | - Michele Schiappoli
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 35134 Verona, Italy; (M.S.); (B.O.)
| | - Gianenrico Senna
- Department of Medicine, University of Verona, 37129 Verona, Italy; (F.N.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 35134 Verona, Italy; (M.S.); (B.O.)
| | - Patrick Pinter
- Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, Verona University Hospital, University of Verona, 37129 Verona, Italy;
| | - Bianca Olivieri
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 35134 Verona, Italy; (M.S.); (B.O.)
| | - Giancarlo Ottaviano
- Otolaryngology Section, Department of Neurosciences, University of Padova, 35122 Padova, Italy;
| | - Eugenio De Corso
- Otorhinolaryngology Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy;
| | - Marco Caminati
- Department of Medicine, University of Verona, 37129 Verona, Italy; (F.N.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 35134 Verona, Italy; (M.S.); (B.O.)
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11
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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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12
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Caminati M, Micheletto C, Norelli F, Olivieri B, Ottaviano G, Padoan R, Piacentini G, Schiappoli M, Senna G, Menzella F. Safety of dupilumab in T2 airways conditions: focus on eosinophilia across trials and real-life evidence. Expert Opin Biol Ther 2024; 24:15-23. [PMID: 38197326 DOI: 10.1080/14712598.2024.2304556] [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: 11/28/2023] [Accepted: 01/09/2024] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha subunit, effectively blocks both IL-4 and IL-13 mediated pathways. Its introduction has represented a significant advancement in the treatment of severe asthma and other Type 2 (T2) conditions, including nasal polyps, atopic dermatitis, and eosinophilic esophagitis. To date, Dupilumab has demonstrated optimal efficacy and safety profile. AREAS COVERED The safety profile of dupilumab has been extensively studied, especially for its effects on blood eosinophil count. Transient eosinophil increase during treatment is typically insignificant from a clinical point of view and related to its mechanism of action. Rare cases of hyper-eosinophilia associated with clinical conditions like eosinophilic granulomatosis with polyangiitis (EGPA) and hypereosinophilic syndrome (HES) have been reported. Those cases are often related to the drug's steroid-sparing effect or the natural trajectory of the underlying disease rather than a direct cause-effect relationship with dupilumab. EXPERT OPINION The management of hyper-eosinophilia during dupilumab treatment requires comprehensive diagnostic work-up and strict follow-up monitoring for early detection of systemic disease progression in order to avoid unnecessary discontinuation of an effective treatment. This approach highlights the importance of a personalized treatment.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | | | | | - Bianca Olivieri
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | - Giancarlo Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - Roberto Padoan
- Division of Rheumatology, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Michele Schiappoli
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | - Francesco Menzella
- Pulmonology Unit, S. Valentino Hospital, AULSS 2 Marca Trevigiana, Treviso, Italy
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13
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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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14
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Kilty SJ, Lasso A. Canadian Real-World Study Long-Term Clinical Results Using Dupilumab for Chronic Rhinosinusitis With Polyps. J Otolaryngol Head Neck Surg 2024; 53:19160216241278659. [PMID: 39345032 PMCID: PMC11450752 DOI: 10.1177/19160216241278659] [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: 02/28/2024] [Accepted: 07/24/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Dupilumab, an anti-IL4 receptor-α monoclonal antibody, was the first biologic to be approved in Canada for the treatment of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). In phase III clinical trials, it has demonstrated to be effective in reducing nasal polyp size and the severity of symptoms, improve disease-specific quality of life, and to have an acceptable safety profile. This study aims to present long-term follow-up data on disease-specific sinonasal outcomes of patients with CRSwNP who have been treated with dupilumab for up to 3 years in a real-world setting. METHODS Retrospective review of electronic medical records of a single Canadian rhinology center evaluating disease-specific sinonasal outcomes that are routinely collected for clinical care. This study included all patients who received dupilumab for the treatment of CRSwNP and who had completed at least one follow-up visit. The Sino-Nasal Outcome Test (SNOT)-22 was used to evaluate treatment symptom improvement. RESULTS Ninety-nine patients started dupilumab therapy during the study period. The mean SNOT-22 at the start of therapy was 61.1 (±22.91) At the time of the review, 65 patients had completed 1 year of therapy, 40 had completed 2 years of therapy, and 18 had completed 3 years of therapy. The mean SNOT-22 score at these timepoints was 16.75 (±13.86), 15.02 (±14.40), and 10.22 (±11.56), respectively. CONCLUSION This real-world study shows that in patients with CRSwNP treated with dupilumab, improvement in disease-specific quality of life seen after 1 year continues and can be maintained at 3 years of treatment.
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Affiliation(s)
- Shaun J. Kilty
- Department of Otolaryngology—Head and Neck Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Andrea Lasso
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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15
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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: 15] [Impact Index Per Article: 15.0] [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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16
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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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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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Piazzetta GL, Lobello N, Chiarella E, Rizzuti A, Pelaia C, Pelaia G, Lombardo N. Targeting IL-4 and IL-13 Receptors on Eosinophils in CRSwNP Patients: The Clinical Efficacy of Dupilumab. J Pers Med 2023; 13:1404. [PMID: 37763171 PMCID: PMC10532854 DOI: 10.3390/jpm13091404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease linked to type 2 inflammation. Several biologics have demonstrated therapeutic potential for the treatment of this pathology in which IL-4, IL-5 and IL-13 represent the major cytokines involved in the control of eosinophilic respiratory inflammation. 25% of CRSwNP patients relapse after the use of oral glucocorticoids or after surgery and often require several surgeries during their lifetime. In our study we enrolled 14 patients, 11 male and 3 female. The inclusion criteria were: age ≥ 18 years; confirmed diagnosis of chronic rhinosinusitis with severe nasal polyposis; disease severity with NPS Nasal Polyposis Endoscopic Score total score ≥ 5 and/or SNOT-22 ≥ 50; previous treatment failure due to lack of efficacy or discontinuation of systemic corticosteroid therapy and/or non-response or recurrence following surgery. The results presented in this study showed the ability of Dupilumab to improve all the parameters analysed. In particular, statistically significant data were obtained for NPS, SNOT-22, NRS, and IgE in patients exposed to Dupilumab treatment for 24 weeks, highlighting the ability of Dupilumab to produce clinical benefit in CRWwNP patients. In light of these data, the administration of dupilumab every two weeks represents a valid clinical strategy that ENT specialists can adopt for the treatment of adults with inadequately controlled CRSwNP.
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Affiliation(s)
- Giovanna Lucia Piazzetta
- Otolaryngology Head and Neck Surgery, Department Medical and Surgical Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (G.L.P.); (N.L.); (A.R.)
| | - Nadia Lobello
- Otolaryngology Head and Neck Surgery, Department Medical and Surgical Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (G.L.P.); (N.L.); (A.R.)
| | - Emanuela Chiarella
- Laboratory of Molecular Haematopoiesis and Stem Cell Biology, Department of Experimental and Clinical Medicine, University “Magna Græcia”, 88100 Catanzaro, Italy;
| | - Alberta Rizzuti
- Otolaryngology Head and Neck Surgery, Department Medical and Surgical Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (G.L.P.); (N.L.); (A.R.)
| | - Corrado Pelaia
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (C.P.); (G.P.)
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (C.P.); (G.P.)
| | - Nicola Lombardo
- Otolaryngology Head and Neck Surgery, Department Medical and Surgical Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (G.L.P.); (N.L.); (A.R.)
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19
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Loperfido A, Ciofalo A, Cavaliere C, Begvarfaj E, Cascone F, Alfonzo G, Cadeddu R, Millarelli S, Bellocchi G, Greco A, de Vincentiis M, Masieri S. Dupilumab's Impact on Blood Parameters in Nasal Polyposis: 18-Month Follow-Up in Real Life. J Immunol Res 2023; 2023:4027701. [PMID: 37745203 PMCID: PMC10516700 DOI: 10.1155/2023/4027701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/30/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Background Dupilumab represents the first approved biological for severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). Objective Aim of this paper is to provide a multicentric real-life study about treatment with dupilumab for CRSwNP with a special focus on blood parameters and IgE, IgG, and IgA. Method A retrospective data collection was jointly conducted at the Otolaryngology departments of San Camillo Forlanini Hospital and University of Rome "La Sapienza" from December 2020 to January 2023. Results A total of 130 patients were included in the study. Monitoring our patients for 18 months, we observed a reduction in nasal polyposis and an improvement in symptoms and their impact on quality of life. Regarding blood tests, a transient increase in blood eosinophils was found in most cases. Total IgE showed a gradual decrease in values. IgG and IgA also showed a slight reduction of values, while remaining within normal ranges. Conclusion To the best of our knowledge, this is the first study to evaluate the impact of dupilumab on several blood parameters in patients receiving treatment for CRswNP. Further studies are needed to confirm our results and to understand the underlying immunological mechanisms.
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Affiliation(s)
| | - Andrea Ciofalo
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Elona Begvarfaj
- Department of Sense Organs, Sapienza University, Rome, Italy
| | | | - Giacomo Alfonzo
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Rosalba Cadeddu
- Department of Sense Organs, Sapienza University, Rome, Italy
| | | | | | - Antonio Greco
- Department of Sense Organs, Sapienza University, Rome, Italy
| | | | - Simonetta Masieri
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
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20
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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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21
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Galletti C, Barbieri MA, Ciodaro F, Freni F, Galletti F, Spina E, Galletti B. Effectiveness and Safety Profile of Dupilumab in Chronic Rhinosinusitis with Nasal Polyps: Real-Life Data in Tertiary Care. Pharmaceuticals (Basel) 2023; 16:ph16040630. [PMID: 37111387 PMCID: PMC10141684 DOI: 10.3390/ph16040630] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by a type 2 pattern of inflammation resulting in the production of some cytokines. Dupilumab radically changes the treatment of CRSwNP, but, considering its recent approval, it may be useful to evaluate its safety profile in a real-world setting. This work aimed to prospectively highlight the effectiveness and safety profile of dupilumab in patients with CRSwNP enrolled in the Otorhinolaryngology Unit of the University Hospital of Messina. An observational cohort study was carried out considering all patients treated with dupilumab. A descriptive analysis was conducted reporting all demographic characteristics, endoscopic evaluations, and symptom conditions. A total of 66 patients were treated with dupilumab, but three patients were excluded due to a lack of adherence during the observational period. A statistically significant reduction in the Sino-Nasal Outcome Test 22 (SNOT-22) and nasal polyps score (NPS) was shown at the 6th and 12th months compared to baseline values (SNOT-22, -37 and -50, p < 0.001 for both comparisons; NPS, -3 and -4, p < 0.001 for both comparisons). During the follow-up, eight patients (12.7%) had a reaction at the site of injection, and seven (11.1%) had transient hypereosinophilia. Given the optimal treatment response and the minimal adverse effects observed, clinicians should consider dupilumab a safe and effective treatment. Further studies are necessary to better understand the long-term effects.
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Affiliation(s)
- Cosimo Galletti
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, 98100 Messina, Italy
| | | | - Francesco Ciodaro
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, 98100 Messina, Italy
| | - Francesco Freni
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, 98100 Messina, Italy
| | - Francesco Galletti
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, 98100 Messina, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Bruno Galletti
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, 98100 Messina, Italy
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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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23
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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: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
Background The 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. Objective To 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. Methods Clinical, 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. Results Among 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). Conclusion Our 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
| | - 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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