Mingrui Deng, Rao Fu, Mei Lv, Ya Feng

Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People’s Republic of China

Correspondence: Mei Lv, Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, People’s Republic of China, Email Lv_mei@163.com Ya Feng, Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, People’s Republic of China, Email fengya1102@sina.com

Purpose: To report the efficacy of a case of IL-4 receptor subunit (IL-4Rα) monoclonal antibody (dupilumab) in treating primary chronic rhinosinusitis with nasal polyps (CRSwNP) refractory repeated short-term oral corticosteroids.
Patients and Methods: The clinical efficacy, subjective and objective scores, and adverse events before and after dupilumab treatment were evaluated to determine the effect of dupilumab on CRSwNP.
Results: The patient’s Lund‒Mackay score on sinus Computed Tomography (CT) at the first visit was 21. After being treated with intranasal corticosteroids, oral corticosteroids, mucoregulatory agents, and nasal isotonic saline irrigation for 3 months, the symptoms did not improve significantly. The CT score was 20. The patient explicitly refused functional endoscopic sinus surgery (FESS) and was treated with dupilumab. During treatment, the patient did not experience dupilumab-related adverse reactions, and the patient’s sinusitis symptoms were completely controlled. In particular, before dupilumab treatment, the patient lost their sense of smell, with a SNOT-25 score of 65; after the first dose of dupilumab, their sense of smell significantly improved. During the 6-month follow-up, the patient consciously recovered their sense of smell, with a SNOT-25 score of 3. After re-examining the sinus CT image, the Lund–Mackay score was 2.
Conclusion: By specifically inhibiting the IL-4 and IL-13 pathways, dupilumab can significantly improve sinusitis symptoms and olfactory function in CRSwNP patients, and significantly reduce the number of acute exacerbations of chronic rhinosinusitis, the range of sinusitis lesions, and the level of systemic corticosteroids.

Keywords: chronic rhinosinusitis with nasal polyps, dupilumab, biological agent, type II inflammation, IL-4Rα