Eosinophilic or not eosinophilic: dupilumab seems to work
Reviewed by Hassan Mohammed

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammation with interleukin (IL)-4, IL-13, and IL-5. Tissue eosinophilia in nasal polyps dramatically increased over a 10-20-year period. Classification of the severity of eosinophil status is expected to lead to better treatment outcomes. Dupilumab is a fully human VelocImmune®-derived monoclonal antibody that blocks the shared receptor component for IL 4 and IL 13. In the SINUS-52 (NCT02898454) phase III study, the coprimary endpoints of changes from baseline to week 24 in nasal polyp score (NPS), nasal congestion/obstruction (NC), and Lund-Mackay score assessed by CT (LMK-CT) were met. The aim of this study was to determine whether eosinophilic status in CRSwNP, classified using the JESREC algorithm, was a predictor of dupilumab efficacy compared with placebo in patients with severe CRSwNP enrolled in the SINUS-52 study. SINUS-52 was a multinational, multicentre, randomised, double-blind, placebo-controlled, parallel-group study of dupilumab in patients with severe uncontrolled CRSwNP. It included 448 patients. In patients with severe, uncontrolled CRSwNP, dupilumab as an add-on to mometasone furoate nasal spray improved disease control, symptom burden, sense of smell, and health-related quality of life. This was regardless of the severity of eosinophilic status. This study demonstrates that dupilumab appears to be effective in management of CRSwNP. Cost and length of treatment might affect its widespread use.

Dupilumab efficacy in chronic rhinosinusitis with nasal polyps from SINUS-52 is unaffected by eosinophilic status.
Fujieda S, Matsune S, Takeno S, et al.
ALLERGY
2022;77(1):186-96.