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. 2025 Jan 16;4(2):100412.
doi: 10.1016/j.jacig.2025.100412. eCollection 2025 May.

Effectiveness of dupilumab treatment against refractory eosinophilic chronic rhinosinusitis

Daiki Nakashima  1   2 , Tsuguhisa Nakayama  1   3 , Shunsuke Minagawa  1   4 , Tetsuya Adachi  1   5 , Chieko Mitsuyama  1 , Yoko Shida  1 , Tsuneya Nakajima  1 , Shin-Ichi Haruna  1   3 , Yoshinori Matsuwaki  1
Affiliations

Effectiveness of dupilumab treatment against refractory eosinophilic chronic rhinosinusitis

Daiki Nakashima et al. J Allergy Clin Immunol Glob. .

Abstract

Background: Eosinophilic chronic rhinosinusitis (ECRS) is a subgroup of chronic rhinosinusitis with nasal polyps (CRSwNP), which is a disease characterized by eosinophilic infiltration of the sinonasal mucosa. Few studies that reported the effect of dupilumab on CRSwNP focused on a single phenotype of CRSwNP, such as ECRS.

Objectives: This study aimed to determine the effectiveness of dupilumab in ECRS with postoperative recurrence.

Methods: We retrospectively enrolled 107 patients and assessed the effectiveness of dupilumab by various clinical outcomes. We performed multivariable analysis on nasal polyp score (NPS) and computed tomography score and a meta-analysis of the effect of dupilumab on chronic rhinosinusitis regarding improvement in the NPS.

Results: At 12 months of dupilumab treatment, there were 65 patients (60.7%) in the excellent response group and 42 (39.3%) in the moderate response group. Nasal polyps had disappeared in 91 patients (85.9%) at 12 months, and there was improvement in all end points; 104 patients (97.2%) were able to eliminate systemic corticosteroid therapy. In the multivariate analysis, male sex was significantly associated with patients who did not show an improvement to 0 in the NPS and computed tomography score (odds ratios: 7.58 and 2.45; P = .01 and P = .04, respectively). The meta-analysis showed that dupilumab treatment resulted in a trend toward better improvement in the NPS (mean difference = -5.41) than previously reported results.

Conclusions: Dupilumab shows effectiveness in treating ECRS and could serve as an alternative therapeutic option to systemic corticosteroids. This effectiveness may be further enhanced by limiting the target population to recurrent ECRS.

Keywords: Eosinophilic chronic rhinosinusitis; corticosteroid; dupilumab; meta-analysis.

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Conflict of interest statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Disclosure of potential conflict of interest: T. Nakayama reports lecture fees from Sanofi. Y. Matsuwaki received an honorarium from Olympus Corporation. The rest of the authors declare that they have no relevant conflicts of interest.

Figures

Fig 1
Fig 1
Comparison of the therapeutic effects of dupilumab treatment for ECRS between before treatment (baseline) and at 3 and 12 months after treatment. Data were analyzed by the Wilcoxon signed-rank test; ∗P < .05, ∗∗P < .01. SAOQ, Self-Administered Odor Questionnaire.
Fig 2
Fig 2
Alluvial plots of the nasal polyp score, computed tomography score, T&T recognitive threshold score, and Open Essence score (A) and the therapeutic response based on EPOS 2020 (B).
Fig 3
Fig 3
Line graphs show changes in the mean ± SE of the prednisolone dose and mean ± SE of the dupilumab dosing interval after dupilumab therapy. The horizontal axis represents the weeks from starting dupilumab therapy. The left vertical axis represents the prednisolone dose (mg/day), and the right vertical axis represents dupilumab dosing therapy (weeks).
Fig 4
Fig 4
Meta-analysis of the effectiveness of dupilumab as assessed by the nasal polyp score. MD, Mean difference.
See this image and copyright information in PMC

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