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Very Rapid Improvement in Extended Nitric Oxide Parameters Is Associated With Clinical and Functional Improvement in Patients With Chronic Rhinosinusitis With Nasal Polyps Treated With Dupilumab

Paoletti G1,2, Casini M1,2, Malvezzi L1, Pirola F1,2, Russo E1,2, Nappi E1,2, Muci GQ1,2, Montagna C1,2, Messina MR1,2, Ferri S1, Racca F1, Lamacchia D1, Cataldo G1, Puggioni F1, De Virgilio A1,2, Ferreli F1,2, Mercante G1,2, Spriano G1,2, Canonica GW1,2, Heffler E1,2

1IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
2Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

J Investig Allergol Clin Immunol 2023; Vol 33(6) : 457-463
doi: 10.18176/jiaci.0851

Background: Dupilumab, an anti–IL-4 receptor a monoclonal antibody, was recently approved for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and moderate-to-severe asthma. Onset of its clinical effects is rapid. CRSwNP is characterized by extended type 2 inflammatory involvement that can be assessed using extended nitric oxide analysis.
Objectives: We investigated whether dupilumab was associated with a rapid improvement in extended nitric oxide parameters, lung function, and clinical outcomes in patients with CRSwNP.
Methods: Consecutive patients with CRSwNP and an indication for dupilumab were evaluated for extended nitric oxide analysis (exhaled, FeNO; bronchial, JawNO; alveolar, CalvNO; nasal, nNO) and lung function 15 and 30 days after initiation of treatment and for clinical outcomes (nasal polyps score [NPS], quality of life questionnaires, visual analog scale [VAS] for the main symptoms, and the Asthma Control Test [ACT]) 30 days after initiation of treatment.
Results: We enrolled 33 patients. All extended nitric oxide and lung function parameters improved significantly after 15 days of treatment, remaining stable at 30 days. Scores on the NPS, VAS for the main CRSwNP symptoms, quality of life questionnaires, and the ACT improved significantly 30 days after initiation of treatment.
Conclusions: Dupilumab is associated with very rapid improvement in type 2 inflammation in all airway areas. This is associated with improved lung function and clinical parameters in patients with CRSwNP.

Key words: Chronic rhinosinusitis, Nasal polyps, Asthma, Dupilumab, Biologics, Nitric oxide, Breath analysis, Lung function