Section: 
Rhinology issues
Rhinology issuesImpact of surgical history on efficacy of biological therapy with dupilumab in patients with severe chronic rhinosinusitis with nasal polyps and concomitant bronchial asthma
D. A. Sivokhin (1), V. M. Svistushkin (2), E. S. Shchennikova (3), E. R. Danelyan (4), N. P. Knyazheskaya (5), A. A. Kameleva (6)
(1), (2), (3), (4) Sechenov First Moscow State Medical University (Sechenov University), Moscow, 119991, Russian Federation, (5) Pirogov Russian National Research Medical University, Moscow, 117997, Russian Federation, (6) Yudin City Clinical Hospital of Moscow Healthcare Departmen, Moscow, 105077, Russian Federation, (6) Russian University of Peoples’ Friendship, Moscow, 117198, Russian Federation
UDK: УДК 616.216-006.5-031.87+616.248]-085:615.37-036.8
DOI: https://doi.org/10.18692/1810-4800-2025-1-30-37
ABSTRACT
Abstract. Introduction. Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a chronic inflammatory disease frequently associated with bronchial asthma and other comorbid Type 2 (T2)-associated conditions. Biologic therapy, particularly dupilumab, represents an innovative treatment approach. However, the impact of surgical history on its efficacy remains insufficiently studied. Objective. To evaluate prior surgical interventions as a prognostic marker for the efficacy of dupilumab therapy in patients with severe CRSwNP and comorbid bronchial asthma. Methods. A cohort observational study was conducted in which patients with severe CRSwNP were divided into three groups: no surgery, one surgery, and two or more surgeries for CRSwNP in their history. All participants received biological therapy with dupilumab for 52 weeks. Efficacy was assessed using the Nasal Polyp Score (NPS) and computed tomography (CT) assessment according to the Lund—Mackay score. Results. The highest efficacy of dupilumab was observed in patients of group 1: polyp reduction was 75.3% by week 52 of therapy according to the NPS. Patients with one or more surgeries demonstrated a lower rate and extent of polyp reduction (54.1 and 56.4%, respectively). According to the Lund—Mackay score, the best dynamics were noted in the group without surgeries: at week 52, the indicator decreased by 77.5% (from 21.45±2.82 to 4.79±3.03 points), in the second and third groups the decrease was 58.8% (to 8.41±3.69) and 54.4% (to 9.53±3.91), respectively. These results highlight that the presence of surgery is associated with a lower response to therapy. Conclusion. Biological therapy with dupilumab is effective for the treatment of severe CRSwNP. However, a history of surgery predicts a lower response, and early initiation of therapy before surgery may improve long-term outcomes.
Publication date:
20.02.2025
Keywords:
chronic rhinosinusitis with nasal polyps, dupilumab, biological therapy, nasal polyps, paranasal sinuses, type 2 inflammation, Nasal Polyp Score, Lund—Mackay score, surgical history, asthma For citation:
Sivokhin D. A., Svistushkin V. M., Shchennikova E. S., Danelyan E. R., Knyazheskaya N. P., Ka-meleva A. A. Impact of surgical history on efficacy of biological therapy with dupilumab in patients with severe chronic rhinosinusitis with nasal polypsand concomitant bronchial asthma. Russian Otorhinolaryngology. 2025;24(1):30-37. (In Russ.) https://doi.org/10.18692/1810-4800-2025-1-30-37