A Study on Changes in Nasal Polyps and Olfactory Dysfunction Treated with Dupilumab in 7 Cases of Chronic Rhinosinusitis with Nasal Polyps

Abstract

Dupilumab is a humanized anti-human IL-4/13 receptor monoclonal antibody that has been approved for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), bronchial asthma, atopic dermatitis, prurigo nodularis, and chronic spontaneous urticaria that respond insufficiently to existing treatments. Some patients with CRSwNP experience repeated relapses while receiving existing treatments, and for such cases, treatment with dupilumab is promising.

In this study, we compared the changes in the nasal polyps and olfactory dysfunction in 7 patients with CRSwNP who were treated with dupilumab. Some of the patients showed improvement of the olfactory dysfunction, and in all cases, the improvement was greater than that achieved with systemic steroid therapy. This difference in the response to the two treatments could possibly be explained by the presence of glucocorticoid receptor beta (GRβ) in the lesions, which attenuates the effects of systemic steroids, but does not the actions of dupilumab.

Dupilumab is a drug that primarily targets nasal polyps and nasal congestion rather than olfactory dysfunction, which limits its approved indications in cases of CRSwNP. As a result, some patients whose symptoms cannot be effectively managed with existing therapies might not meet the criteria for use of the drug, even if they could benefit from dupilumab. In such cases, exploring alternative target diseases such as bronchial asthma could be a viable approach. To facilitate this, it is advisable to collaborate with physicians from other specialties to discuss the potential indications of the drug.