Meeting abstract
Predictive value of comorbid asthma and blood eosinophil count for the efficacy of dupilumab – a one-year follow-up under real world conditions
Marko Sikirica
; KBC Split, Spinčićeva 1, 21000 Split, Hrvatska
Abstract
Introduction: Chronic rhinosinusitis (CRS) is an inflammatory disease of the upper respiratory tract, that can
be divided into type 2 (T2) and non–type 2 endotype. Type 2 CRS is characterized by eosinophilic
inflammation and elevated levels of IL-4, IL-5, and IL-13, and is often associated with asthma, allergy, and
chronic rhinosinusitis with nasal polyposis (CRSwNP) (Fokkens et al., 2020). These patients often have a more
severe disease course, frequent recurrences and a poor response to conventional therapy, whereas the biologics
of targeting type 2 inflammation have shown good efficacy (Bachert et al., 2019; Klimek et al., 2022).
Dupilumab, an IL-4/IL-13 receptor antagonist, was approved for the treatment of CRSwNP refractory to
standard therapy. The aim of the study was to investigate the therapeutic effect of dupilumab over a 12-month
treatment period under real-world conditions and to examine whether comorbid asthma and the level of
peripheral blood eosinophil count have an impact on the response to therapy. Methods: The study included
249 patients with severe CRSwNP, 82.3% of whom had asthma. The patients were divided into four groups
based on their asthma status and blood eosinophil count: (1) no asthma and <300 eosinophils/µL; (2) no asthma
and ≥300 eosinophils/µL; (3) asthma and <300 eosinophils/µL; (4) asthma and ≥300 eosinophils/µL. All the
patients were evaluated at baseline, six months, and 12 months. The outcome measures included SNOT-22,
VAS scores, Bachert’s nasal polyp score, a smell test and peripheral blood eosinophil count. Statistical analysis
was performed using nonparametric tests. Results: All clinical parameters showed improvement within six
months (p < 0.05), and the effect was maintained up to 12 months. SNOT-22 and VAS scores decreased. The
Sniffing sticks test confirmed an improved sense of smell and Bachert’s scale indicated a reduction in polyp
size. Comorbid asthma and eosinophil count had no significant impact on the therapeutic effect. The Kruskal
Wallis test at 12 months showed no statistically significant differences between the groups. Conclusion:
Dupilumab over 12 months improves the symptoms, endoscopic findings, and olfactory function in patients
with CRSwNP. The therapeutic effect is consistent regardless of the presence of asthma or eosinophil levels,
confirming its efficacy in treating patients with type 2 CRS.
Keywords
chronic rhinosinusitis with nasal polyposis; dupilumab; eosinophils; asthma
Hrčak ID:
336427
URI
Publication date:
10.11.2025.
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