Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilians University of Munich, Munich, Federal Republic of Germany.
Department of Otorhinolaryngology, University Hospital, Ludwig-Maximilians University of Munich, Munich, Federal Republic of Germany.
Medicine (Baltimore). 2022 Nov 11;101(45):e31031. doi: 10.1097/MD.0000000000031031.
Dupilumab has been shown to be safe and effective in treating chronic rhinosinusitis with polyposis (CRSwNP). There is to this date no published data whether subgroups like patients with aspirin exacerbated respiratory disease (AERD), increased histologic eosinophilia or elevated blood eosinophil or IgE-levels benefit greater from dupilumab therapy. Moreover, there is no data comparing the efficacy of functional endoscopic sinus surgery (FESS) with dupilumab therapy. We conducted a retrospective chart review of all patients that were treated at a tertiary referral center for CRswNP with dupilumab. We also contacted the patients with a questionnaire to evaluate the efficacy of previous surgeries and dupilumab therapy by visual analogue scale (VAS) and the glasgow benefit inventory (GBI) as well as report on side effects. Overall, 75 patients were included in the study at hand that reported back 138 times. While dupilumab treatment was efficient, we found no systematic evidence of greater efficacy of dupilumab in patients with AERD, histologic eosinophilia or increased blood eosinophil or IgE-levels. All patients showed a considerable decrease in subjective burden of disease, objective smell tests and endoscopic findings. From the patients point of view, dupilumab therapy showed greater efficacy both in the VAS and the GBI overall and all subcategories but "social support." Dupilumab is efficient in treating CRSwNP; this effect is independent from disease characteristics like AERD, histologic eosinophilia, serum IgE-levels or eosinophil counts. There seems to be a group of patients that benefit greater from dupilumab therapy compared to FESS.
度普利尤单抗已被证明在治疗伴有息肉的慢性鼻-鼻窦炎（CRSwNP）方面是安全且有效的。迄今为止，尚无关于亚组患者（如阿司匹林加重的呼吸道疾病[AERD]患者、组织学嗜酸性粒细胞增多或血嗜酸性粒细胞或 IgE 水平升高患者）是否能从度普利尤单抗治疗中获益更多的相关数据。此外，尚无比较功能性内镜鼻窦手术（FESS）与度普利尤单抗治疗疗效的数据。我们对在一家三级转诊中心接受度普利尤单抗治疗 CRSwNP 的所有患者进行了回顾性图表审查。我们还通过视觉模拟量表（VAS）和格拉斯哥获益量表（GBI）以及报告副作用的方式联系了患者，以评估既往手术和度普利尤单抗治疗的疗效。总体而言，我们纳入了研究中的 75 名患者，他们共报告了 138 次。尽管度普利尤单抗治疗有效，但我们未发现系统性证据表明 AERD、组织学嗜酸性粒细胞增多或血嗜酸性粒细胞或 IgE 水平升高患者的度普利尤单抗疗效更大。所有患者的疾病主观负担、嗅觉测试和内镜检查结果均有显著下降。从患者的角度来看，度普利尤单抗治疗在 VAS 和 GBI 整体及所有亚组中（除了“社会支持”）均显示出更大的疗效。度普利尤单抗治疗 CRSwNP 有效；这种疗效与疾病特征（如 AERD、组织学嗜酸性粒细胞增多、血清 IgE 水平或嗜酸性粒细胞计数）无关。与 FESS 相比，似乎有一群患者从度普利尤单抗治疗中获益更多。
