Author(s)
Kelsey Limage, BS
Emma Tam
Kalena Liu
Samuel Shing, BS
Srihari Daggumati, Dr.
Marc Rosen, MD, FARS
Mindy Rabinowitz, MD, FARS
Elina Toskala, MD, FARS
Gurston Nyquist, MD, FARS
Affiliation(s)
Thomas Jefferson University
Abstract:
Background:
Patients with refractory chronic rhinosinusitis with nasal polyps (CRSwNP) are often treated with dupilumab, an IL-4 receptor antagonist. There is limited literature assessing the predictive value of clinical biomarkers and nasal assessments in this patient population.
Objective:
To determine the effect of baseline absolute eosinophil counts (AEC), IgE, nasal polyp scores (NPS) and clinical assessments on outcomes in patients with CRSwNP receiving dupilumab.
Methods:
A retrospective review of adults with CRSwNP treated with dupilumab was performed from 2019 to 2024. Pretreatment AEC, IgE, nasal assessment scores, and clinical outcomes up to 1 year after treatment were collected. Descriptive statistics, t-tests, and regression analysis were performed.
Results:
In our cohort of 68 patients, dupilumab treatment led to significant clinical improvement. Patients with high pre-treatment NPS (=5) showed a greater degree of improvement in total SNOT score (p=0.079) and NPS at 1-year follow-up (p<0.001). Multivariate regression revealed baseline SNOT score (OR=1.57, p<0.001) and age (OR=1.37, p=0.005) significantly predicted follow-up SNOT score. Baseline AEC, IgE levels, and time from previous surgery did not significantly predict the degree of improvement in outcomes.
Discussion:
Patients with nasal polyposis requiring biologic therapy had significant clinical improvement at 1-year follow-up. NPS >5 predicted a greater reduction in polyp score at 1-year follow-up. In this cohort, only baseline NPS and SNOT scores showed significant predictive value. This suggests dupilumab effectively treats CRSwNP in patients with high disease severity, including those with variable eosinophil or IgE levels.