Dupilumab is effective in improving asthma outcomes in patients with coexisting chronic rhinosinusitis and nasal polyps, and it can reduce the need for oral corticosteroids and improve patients’ quality of life.
People with asthma also experience chronic rhinosinusitis and nasal polyps (CRS-NPs), and allergic rhinitis, and they have a higher disease burden and are more likely to have these coexisting conditions. Interleukin (IL)-4, IL-13, and IL-5, play a crucial role in developing asthma and CRS. Dupilumab, a fully human monoclonal antibody, inhibits the shared receptor component for IL-4 and IL-13, which are essential and central drivers of type 2 inflammation in multiple diseases. A study evaluated the role of dupilumab in individuals with moderate-to-severe (phase 3 LIBERTY ASTHMA QUEST study) or oral corticosteroid (OCS)-dependent (phase 3 LIBERTY ASTHMA VENTURE study) asthma with or without coexisting CRS-NP.These findings are reported in Annals of Allergy, Asthma & Immunology.
Annualized Rate of Severe Exacerbations
Significant decreases were found in the annualized exacerbation rate in the dupilumab group compared to the placebo group in patients with and without self-reported coexisting chronic CRS-NP. During a span of 52 weeks, the annual exacerbation rates of patients diagnosed with CRS-NP declined from 2.36 to 1.48 in the placebo group, and from 2.39 to 0.50 in the group treated with dupilumab. This trend continued over the 96-week treatment period, with annualized exacerbation rates of 0.41 and 0.32 in placebo/dupilumab and dupilumab/dupilumab patients with CRS-NP and 0.34 and 0.33 in in placebo/dupilumab and dupilumab/dupilumab patients without CRS-NP, respectively.
Oral Corticosteroid Dose
The study evaluated the efficacy of dupilumab in reducing OCS use in patients with CRS-NP. The results showed that patients who received dupilumab experienced greater reductions in OCS use compared to those who received placebo. The reduction was more significant in patients with self-reported CRS-NP.
Changes in Prebronchodilator Forced Expiratory Volume
Substantial improvements in forced expiratory volume in 1 second (FEV1) were observed in patients with or without self-reported CRS-NP, which were maintained during the phase IIb TRAVERSE study.
Benefits of Dupilumab Treatment on Patient-Reported Symptom Questionnaire Scores
Patients who received dupilumab had sustained improvements in Asthma Control Questionnaire 5 (ACQ-5) and Asthma Quality of Life Questionnaire (AQLQ) scores from week 0 to week 48, while patients who received placebo had lower changes in scores.
Treatment-Emergent Adverse Events
The safety rates of treatment-emergent adverse events (TEAEs) were similar across the treatment groups in patients with and without self-reported coexisting CRS-NP. A higher proportion of patients with vs. without self-reported coexisting CRS-NP reported serious TEAEs in both treatment groups.
Berger, P., Menzies-Gow, A., Peters, A. T., Kuna, P., Rabe, K. F., Altincatal, A., Soler, X., Pandit-Abid, N., Siddiqui, S., Jacob-Nara, J. A., Deniz, Y., & Rowe, P. J. (2023). Long-term efficacy of dupilumab in asthma with or without chronic rhinosinusitis and nasal polyps. Annals of Allergy, Asthma, and Immunology, 130(2), 215-224. https://doi.org/10.1016/j.anai.2022.11.006