Dupilumab Improves Chronic Rhinosinusitis With Nasal Polyps, Comorbid Asthma

Dupilumab may improve upper and lower airways outcomes in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and comorbid asthma regardless of their asthma characteristics, according to clinical trial findings presented at the 2021 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting, held in New Orleans, LA, from November 4 to 8.

Dupilumab, a dual inhibitor of interleukin (IL)-4 and IL-13 signaling, is approved worldwide for inadequately controlled CRSwNP and moderate-to-severe asthma as primary indications. Investigators of the randomized, double-blind SINUS-24/52 studies (ClinicalTrials.gov Identifiers: NCT02912468 and NCT02898454) evaluated the efficacy of dupilumab on CRSwNP and asthma outcomes in patients with CRSwNP and comorbid asthma, according to baseline asthma characteristics.

Out of 724 patients in the pooled SINUS-24/52 population, 428 (59.1%) had comorbid asthma; among these patients, 258 received dupilumab at 300 mg and 170 received placebo every 2 weeks for 24 and 52 weeks (W24/W52). Researchers assessed CRSwNP outcomes based on nasal polyp score, nasal congestion, the 22-item Sino-Nasal Outcome Test, loss of sense of smell, and the University of Pennsylvania Smell Identification Test scores. Asthma outcomes in patients with comorbid asthma were assessed based on the 5-item Asthma Control Questionnaire (ACQ-5) score and pre-bronchodilator forced expiratory volume in 1 second (FEV₁).

Post-hoc, change from baseline was analyzed for baseline blood eosinophil counts of 150 or more cells per microliter or 300 or more cells per microliter, ACQ-5 scores less than 1.5 vs 1.5 or higher, and FEV₁ less than 80%. The researchers found that dupilumab significantly improved CRSwNP and asthma outcomes compared with placebo at week 24 (all P <.001), regardless of baseline eosinophil levels, ACQ-5 scores, or FEV₁. The researchers noted similar improvements at week 52 for all outcomes (P <.05) with the exception of FEV₁ in the subgroup with baseline ACQ-5 scores of 1.5 or higher.

“Dupilumab treatment, approved for CRSwNP and asthma as primary indications, improved upper and lower airways outcomes ([week] 24) in patients with CRSwNP and comorbid asthma regardless of differences in clinically relevant baseline asthma characteristics,” the researchers concluded.

Reference

Busse W, Pavord I, Siddiqui S, et al. Dupilumab improves CRSwNP/asthma outcomes in patients with CRSwNP and comorbid asthma irrespective of asthma characteristics. Presented at: American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting; November 4-8, 2021; New Orleans, LA. Abstract P183.