Section: 
Rhinology issues
Rhinology issuesHypereosinophilia during dupilumab treatment in patients with severe uncontrolled chronic rhinosinusitis with nasal polyps
S. A. Rebrova (1), M. A. Budkovaya (2), S. V. Ryazantsev (3)
(1), (2), (3) Saint Petersburg Scientific Research Institute of Ear, Throat, Nose and Speech, Saint Petersburg, 190013, Russian Federation, (2) Saint Petersburg State University, Saint Petersburg, 199034, Russian Federation
UDK: УДК 616.155.35-008.817:616.216-006.5-031.81-07:615.37
DOI: https://doi.org/10.18692/1810-4800-2025-1-21-29
ABSTRACT
Аbstract. Introduction. Hypereosinophilia, often transient, is observed in patients with rhinosinusitis with nasal polyps (RSwNP) during dupilumab therapy. However, there are reports of hypereosinophilia leading to serious clinical manifestations. Objective. To evaluate the impact of hypereosinophilia during dupilumab treatment on the clinical outcome of patients with RSwNP in real-life clinical practice. Research methods. 176 patients over 18 years of age receiving dupilumab 300 mg subcutaneously once every 2 weeks for severe RSwNP were observed. Among these patients, a study group was identified that included patients who had an increase in the level of peripheral blood eosinophils of more than 1,500 cells per μL during the use of biological therapy. The clinical outcomes of treatment were assessed based on the dynamics of changes in the main nasal symptoms, the SNOT-22 questionnaire, the asthma control test (AСT), and an analysis of the distribution of polyps in the nasal cavity using the Nasal Polyp Score (NPS) scale. Results. Among 176 patients, 9 (5.1%) patients had peripheral blood eosinophilia of 1,500 cells per μL and higher during treatment with dupilumab. At the start of therapy, the average level of eosinophils in the peripheral blood was 450 cells per μL. In the fourth month from the start of treatment with dupilumab, a significant increase in the eosinophil level to 1,980 cells was noted, and eosinophilia was not accompanied by clinical symptoms: asthma control did not worsen, and the clinical symptoms of RSwNP improved (a significant decrease in NPS scores, SNOT 22 test indicators). A decrease in the level of peripheral blood eosinophils to 515 cells per μL was observed by the 14th month of dupilumab therapy in 6 (66.7%) patients, and by the 18th month of therapy in 3 (33.3%) patients the eosinophil level returned almost to the initial level. Conclusion. The results of clinical studies indicate a favorable safety profile of T2 targeted biological therapy. Eosinophilia occurring during treatment with dupilumab is often not associated with clinical symptoms. In clinical practice, an individual approach to patients, a thorough assessment of possible adverse events, in particular, hypereosinophilia, and their relationship with treatment are necessary.
Publication date:
20.02.2025
Keywords:
hypereosinophilia, dupilumab, rhinosinusitis with nasal polyps For citation:
Rebrova S. A., Budkovaya M. A., Ryazantsev S. V. Hypereosinophilia during dupilumab treatment in patients with severe uncontrolled chronic rhinosinusitis with nasal polyps. Russian Otorhinolaryngology. 2025;24(1):21-29. (In Russ.) https://doi.org/10.18692/1810-4800-2025-1-21-29