Dupilumab May Reduce Steroid Use in Aspirin-Exacerbated Respiratory Disease

Patients with aspirin-exacerbated respiratory disease (AERD) who received dupilumab required fewer oral steroid pulses and had lower total oral steroid use compared with patients who were treated with aspirin desensitization or endoscopic sinus surgery (ESS) at 1 year. These are the findings of a study presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) 2022 Annual Meeting and OTO Experience, held in Philadelphia, Pennsylvania, September 10 to 14, 2022.

Researchers conducted a retrospective chart review of 100 patients with AERD from a tertiary care center to compare oral steroid use in those who received aspirin desensitization, biologics, and ESS.

Of the cohort, 31 patients had aspirin desensitization after ESS, 30 were receiving dupilumab after ESS, and 39 patients had ESS alone. The researchers compared the post-treatment oral steroid pulse and total oral steroid use at 1 year. The analysis included only patients on dupilumab due to the low number of patients who had received other biologics.

The patients who received aspirin desensitization required a mean of 0.935 steroid pulses/year, for an overall pulse dose of 264 mg/year. Patients who were receiving dupilumab required 0.80 pulses/year, for a total pulse dose of 222 mg/year. The patients who had surgery needed a mean 1.05 pulses/year for 296 mg of annual pulse steroids. The mean total oral steroid use in the 3 treatment groups was 389 mg, 259 mg, and 413 mg, respectively.

Patients who were receiving dupilumab required a lower total dose of oral steroids compared with those who had surgery (P =.026) and aspirin desensitization (P =.671). In addition, “The ESS patients had the highest number of oral steroid pulses and the total annual oral steroid usage,” the researchers concluded.

Reference

Alapati R, D’Souza GE, Rabinowitz M, et al. A comparison of oral steroid use in AERD patients treated with sinus surgery, aspirin sensitization, and biologics. Otolaryngol Head Neck Surg. 2022;167(1 suppl):P142.