First outcomes of bio logical treatment for refractory chronic rhinosinusitis with nasal polyposis at Motol University Hospital

Summary

Introduction: Patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP), meeting the EPOS 2020 criteria, are indicated for biological treatment. The pathogenesis of the disease significantly involves a type II immunopathological response. Treatment involves monoclonal antibodies that block the signaling of inflammatory cytokines. In the Czech Republic, three medications are approved –⁠ dupilumab, mepolizumab, and omalizumab. Methodology: A retrospective study was conducted, comprising of 26 patients treated with dupilumab at the Department of Otorhinolaryngology and Head and Neck Surgery at Motol University Hospital from November 2020 to December 2023. In the study cohort, we monitored the progression of nasal polyp score (NPS) scores, 22-item Sinonasal Outcome Test (SNOT-22), Odourized Markers Test (OMT), IgE levels, eosinophil count, and Asthma Control Test from the beginning of treatment and at week 16, 1 year, and 2 years into treatment. Results: According to the results, there is a statistically significant improvement not only in subjective symptoms but also in the objective findings of most variables. After 1 year of treatment, we observed a statistically significant improvement in NPS (from 6.15 ± 1.35 to 1.69 ± 1.76), SNOT-22 (from 58.83 ± 17.37 to 15.33 ± 16.80), OMT (from 1.52 ± 1.83 to 5.88 ± 3.5), and IgE levels (from 245 ± 251 kIU/l to 64 ± 68 kIU/l). In the study, the effectiveness of biologics was demonstrated in our patient cohort. Conclusion: The aim of this study is to report the initial outcomes of biologic treatment in patients with chronic rhinosinusitis with nasal polyposis treated at the Department of Otorhinolaryngology and Head and Neck Surgery, 1^st Faculty of Medicine, Motol University Hospital. Our study demonstrated a statistically significant improvement in SNOT-22, OMT, NPS, and serum IgE levels. The results were statistically significant when comparing baseline values with the 16-week follow-up, as well as when comparing baseline values with the 1-year follow up. No serious complications were encountered during the course of treatment.

Keywords:

biological treatment – dupilumab – CRSwNP