Dupilumab and Systemic Corticosteroid Use in Patients with CRSwNP and Asthma

For patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma, dupilumab reduced the requirement for systemic corticosteroids (SCS), and improved asthma control, regardless of asthma exacerbation history, according to study findings being presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting, held in Phoenix, Arizona, from February 25 to 28.

In patients with CRSwNP, dupilumab significantly reduced the requirement for SCS during the Phase 3 SINUS-24 and SiNUS-52 studies (ClinicalTrials.gov Identifiers: NCT02912468 and NCT02898454, respectively). Poorer outcomes and refractory disease are typical for patients with coexisting asthma. Researchers sought to determine if dupilumab would also reduce the requirement for SCS in patients with CRSwNP and coexisting asthma. This post hoc analysis included 337 patients, with 167 receiving dupilumab 300 mg every 2 weeks and 170 receiving placebo. Kapan-Meier analysis was used to estimate on-treatment SCS use to week 24. Patients were assessed based on the 6-item Asthma Control Questionnaire (ACQ-6) and their forced expiratory volume in 1 second (FEV₁) both at baseline and week 24.

Researchers found that the requirement for on-treatment SCS — regardless of reason — was significantly lower with dupilumab than placebo (12% with dupilumab vs 40% with placebo; hazard ratio 0.248; 95% CI, 0.150-0.409; P <.0001). The most frequent reasons for SCS use were nasal polyps and asthma (dupilumab/placebo: 3%/27% for nasal polyps; 2%/9% for asthma). FEV₁ and ACQ-6 improved significantly at week 24 with dupilumab vs placebo, regardless of asthma exacerbation history (all P ≤.0001).

Researchers concluded, “Dupilumab reduced the requirement for SCS in patients with CRSwNP and coexisting asthma vs placebo.” Regardless of asthma exacerbation history, asthma control was improved, “demonstrating concomitant reduction of asthma disease burden and SCS use in these patients.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Gurnell M, Menzies-Gow A, Bachert C, et al. Dupilumab reduces asthma disease burden and recurrent SCS use in patients with CRSwNP and coexisting asthma. Presented at: the Presented at: American Academy of Allergy, Asthma & Immunology (AAAAI) 2022 Annual Meeting; February 25–28, 2022; Phoenix, AZ. Abstract 377.