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Biomedicines
Volume 13
Issue 2
10.3390/biomedicines13020501
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Article

Dupilumab in the Treatment of Severe Uncontrolled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) and Comorbid Asthma—A Multidisciplinary Monocentric Real-Life Study

by
Gian Luca Fadda
1,
Chiara Rustichelli
1,
Simone Soccal
2,
Simone Moglio
1,
Alessandro Serrone
1,
Francesca Bertolini
2,
Vitina Carriero
2,
Stefano Pizzimenti
3,
Stefano Levra
2,
Giovanni Cavallo
1,
Fabio Luigi Massimo Ricciardolo
2,3,4 and
Giuseppe Guida
2,3,*
1
Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Regione Gonzole 10, Orbassano, 10043 Turin, Italy
2
Department of Clinical and Biological Sciences, University of Turin, Orbassano, 10043 Turin, Italy
3
Severe Asthma, Rare Lung Disease and Respiratory Pathophysiology, San Luigi Gonzaga University Hospital, Orbassano, 10043 Turin, Italy
4
Institute of Translational Pharmacology, National Research Council (IFT-CNR), Section of Palermo, 90146 Palermo, Italy
*
Author to whom correspondence should be addressed.
Biomedicines 2025, 13(2), 501; https://doi.org/10.3390/biomedicines13020501
Submission received: 2 January 2025 / Revised: 7 February 2025 / Accepted: 13 February 2025 / Published: 17 February 2025
(This article belongs to the Special Issue Recent Advances in Chronic Rhinosinusitis and Asthma)
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Abstract

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma are mutually correlated with Type-2 inflammation. Dupilumab is effective in uncontrolled and relapsing CRSwNP. However, the precise characterization of Type-2 inflammation and the impact of previous surgery on clinical outcomes need clarification. Methods: We present a prospective observational study on a 38 CRSwNP-patient cohort, whose Type-2 endotype was confirmed after a multidisciplinary approach shared among ENTs, pneumologists and allergologists. Patients were treated with dupilumab and evaluated at 15 days and 1-3-6-12-18-24-30 months, focusing on clinical (VAS, nasal polyp score—NPS), radiological (Lund-Mackay) and quality of life (SNOT-22) parameters, as well olfactory function, asthma control, variation of Type-2 markers and number and extent (ACCESS score) of previous surgeries. Results: We confirmed the efficacy of dupilumab in total and sub-items VAS, NPS, SNOT-22 and sniffing score, as well as Lund–Mackay score improvements, observable and significant after 2 weeks of treatment (p < 0.0001) and long-lasting over 30 months. Good to excellent response criteria to biologic treatment at 6 months was observed in 30/32 patients. Comorbid asthma reached rapid control (p < 0.0001) and exhaled nitric oxide normalization was achieved. One single “not adequate” surgery showed a trend to milder improvement, as well as a higher ACCESS score to better olfactory outcome. Conclusions: The accurate selection of uncontrolled relapsing CRSwNP in terms of Type-2 endotyping by multidisciplinary approach can maximize dupilumab efficacy. The number and extent of previous surgeries may differentiate the response, although this effect is difficult to catch in real life. “Adequate” ESS surgery before dupilumab may drive mostly effective disease control.
Keywords: nasal polyps; chronic rhinosinusitis; asthma; type-2 inflammation; biologic treatment; dupilumab; endoscopic sinus surgery; biomarkers nasal polyps; chronic rhinosinusitis; asthma; type-2 inflammation; biologic treatment; dupilumab; endoscopic sinus surgery; biomarkers

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MDPI and ACS Style

Fadda, G.L.; Rustichelli, C.; Soccal, S.; Moglio, S.; Serrone, A.; Bertolini, F.; Carriero, V.; Pizzimenti, S.; Levra, S.; Cavallo, G.; et al. Dupilumab in the Treatment of Severe Uncontrolled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) and Comorbid Asthma—A Multidisciplinary Monocentric Real-Life Study. Biomedicines 2025, 13, 501. https://doi.org/10.3390/biomedicines13020501

AMA Style

Fadda GL, Rustichelli C, Soccal S, Moglio S, Serrone A, Bertolini F, Carriero V, Pizzimenti S, Levra S, Cavallo G, et al. Dupilumab in the Treatment of Severe Uncontrolled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) and Comorbid Asthma—A Multidisciplinary Monocentric Real-Life Study. Biomedicines. 2025; 13(2):501. https://doi.org/10.3390/biomedicines13020501

Chicago/Turabian Style

Fadda, Gian Luca, Chiara Rustichelli, Simone Soccal, Simone Moglio, Alessandro Serrone, Francesca Bertolini, Vitina Carriero, Stefano Pizzimenti, Stefano Levra, Giovanni Cavallo, and et al. 2025. "Dupilumab in the Treatment of Severe Uncontrolled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) and Comorbid Asthma—A Multidisciplinary Monocentric Real-Life Study" Biomedicines 13, no. 2: 501. https://doi.org/10.3390/biomedicines13020501

APA Style

Fadda, G. L., Rustichelli, C., Soccal, S., Moglio, S., Serrone, A., Bertolini, F., Carriero, V., Pizzimenti, S., Levra, S., Cavallo, G., Ricciardolo, F. L. M., & Guida, G. (2025). Dupilumab in the Treatment of Severe Uncontrolled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) and Comorbid Asthma—A Multidisciplinary Monocentric Real-Life Study. Biomedicines, 13(2), 501. https://doi.org/10.3390/biomedicines13020501

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