Predicting dupilumab treatment outcome in patients with primary diffuse type 2 chronic rhinosinusitis. Issue 4 (10th October 2022)

• Record Type: Journal Article
• Authors: Soyka, Michael B.; Ryser, Fabio S.; Brühlmann, Catrin; Fehr, Danielle; Dülgeroglu, Jacqueline; Schmid‐Grendelmeier, Peter; Brüggen, Marie‐Charlotte; Steiner, Urs C.
• Is Part Of: Allergy. Volume 78:Issue 4(2023)
• Page Start: 1036
• Page End: 1046
• Publication Date: 2022-10-10
• Subjects: anti IL‐4/13 -- chronic rhinosinusitis -- eosinophilia -- predictor -- proteomics; Allergy -- Periodicals; 616.97
• DOI: 10.1111/all.15532
• Languages: English
• ISSNs: 0105-4538

Abstract

Abstract: Background: Chronic rhinosinusitis with a type 2 inflammatory pattern (T2CRS) is believed to be restricted to the nose and sinuses and associated with polyps, without clear serologic markers. Dupilumab is a promising new therapy in difficult to treat T2CRS. No factors are known to predict dupilumab treatment outcome. Methods: Patients undergoing dupilumab treatment were assessed clinically to report ultra‐short‐ and short‐term outcome up to 90 days. Serum samples were taken on day 0 and 30 days of treatment, and proteomic analyses were performed using Olink®. The results were compared with healthy controls (HC). The aim was to identify clinical and serological markers associated with a treatment response to dupilumab. Confirmation of predictive parameters was evaluated in a prospective cohort of 20 T2CRS patients. Results: Thirty patients were included, 80% of which were treatment responders. SinoNasalOutcomeTest‐20 (SNOT‐20) scores and the total nasal polyp score improved significantly ( p < .05) on Day 7. An improvement of 2.5 points at the first visit was associated with a favorable outcome with a sensitivity of 86%. Proteomic analyses revealed significant changes compared with HC. Furthermore, we could identify OPG in the serum of dupilumab‐treated patients that may serve as a predictor of the clinical outcome of dupilumab treatment. The predictive value of OPG was confirmed in the second cohort. Conclusion: Clinical response after 1 week of treatment with dupilumab is highly associated with a favorable outcome. High sensitivity proteomic analyses can identify T2CRS‐specific dysregulated proteins in serum. Serum OPG may serve as a predictor for dupilumab treatment outcome before the initiation of any therapy. Abstract : Clinical response to dupilumab treatment in type 2 CRS is very rapid. Serum proteomics identified OPG as a potential predictor of outcome.Abbreviations: CRS, chronic rhinosinusitis; EDAR, ectodysplasin A receptor; OPG, osteoprotegerin; SNOT‐20, sino‐nasal outcome test‐20; TNPS, total nasal polyp score