Pecorari Giancarlo, Urbanelli Anastasia, Garetto Marco, Borro Arianna, Rotolone Nicola, Tosello Alberto, Ferrero Davide, Riva Giuseppe
Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy.
Laryngoscope. 2025 Aug 26. doi: 10.1002/lary.70083.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex and heterogeneous condition. Cluster analyses identified mixed endotypes underlying CRSwNP, characterized by overlapping inflammatory markers, such as the co-expression of T2 and neutrophilic markers. The aim of this prospective observational study was to evaluate the effectiveness of dupilumab for CRSwNP in a real-life setting, comparing different nasal endotypes.
Thirty-one patients with uncontrolled type 2 CRSwNP who underwent biologic therapy with dupilumab were included. Endoscopic examinations, nasal cytology, smell (Visual Analogue Scale-VAS), blood eosinophils, evaluation of quality of life (SNOT-22 questionnaire), and asthma severity (Asthma Control Test-ACT) were performed before starting the treatment (T0) and after 3 (T1), 6 (T2), and 12 months (T3).
A mixed endotype (neutrophil and eosinophil) was observed in 51.6% of cases at T0. An increase of neutrophil infiltrate between T0 and T3 was observed in 51.6% of patients. Such an increase could be present both in patients with a mixed endotype and pure eosinophil endotype at T0. A smaller improvement was observed for SNOT-22 physical symptoms, SNOT-22 nasal symptoms, SNOT-22 total score, and VAS for smell loss in patients with a neutrophil increase. However, such individuals had lower scores in these parameters at T0 and then reached the values of other subjects at T3.
Dupilumab is an effective treatment also in mixed neutrophil-eosinophil endotypes. A peculiar clinical condition with fewer symptoms and better quality of life is present in patients that will have a neutrophil increase at nasal cytology during the treatment.
伴鼻息肉的慢性鼻-鼻窦炎（CRSwNP）是一种复杂的异质性疾病。聚类分析确定了CRSwNP潜在的混合内型，其特征为炎症标志物重叠，如T2和中性粒细胞标志物的共表达。这项前瞻性观察性研究的目的是在现实环境中评估度普利尤单抗治疗CRSwNP的有效性，并比较不同的鼻内型。
纳入31例接受度普利尤单抗生物治疗的2型CRSwNP控制不佳的患者。在开始治疗前（T0）以及治疗3个月（T1）、6个月（T2）和12个月（T3）后，进行内镜检查、鼻细胞学检查、嗅觉（视觉模拟量表-VAS）、血液嗜酸性粒细胞计数、生活质量评估（SNOT-22问卷）和哮喘严重程度评估（哮喘控制测试-ACT）。
在T0时，51.6%的病例观察到混合内型（中性粒细胞和嗜酸性粒细胞）。51.6%的患者在T0至T3期间观察到中性粒细胞浸润增加。这种增加在T0时混合内型和纯嗜酸性粒细胞内型的患者中均可能出现。中性粒细胞增加的患者在SNOT-22身体症状、SNOT-22鼻部症状、SNOT-22总分和嗅觉丧失VAS方面的改善较小。然而，这些个体在T0时这些参数的得分较低，然后在T3时达到其他受试者的值。
度普利尤单抗对中性粒细胞-嗜酸性粒细胞混合内型也是一种有效的治疗方法。在治疗期间鼻细胞学检查中性粒细胞增加的患者中，存在一种症状较少、生活质量较好的特殊临床情况。
