DIFFERENT RESPONSES TO DUPILUMAB ON EOSINOPHILIC ASTHMA WITH CHRONIC RHINOSINUSITIS AFTER TWO CONSECUTIVE ANTI-IL-5 BIOLOGICS THERAPY FOR EACH 2-YEAR

Motohiro Kurosawa*, Kumi Ogawa, Yuji Shimizu, Yujin Sutoh, and Eijin Sutoh

ABSTRACT

Objective: To investigate an efficacy of dupilumab in 4 patients of bronchial asthma with chronic rhinosinusitis (CRS) after 2 consequtive anti-IL-5 biologics therapy for each 2-year. Methods: The diagnostic evidence of CRS was defined using the Lund-Mackay CT score. Outcome measures involved this score as well as the Sino-Nasal Outcome Test-22 (SNOT-22) score, Question 21/22 from the SNOT-22, pulmonary function, and perpheral blood eosinophil count. Results: The first patient, a 54-year-old man, was given dupilumab on August 2020. Eosinophil count, FEV1 (%), the ACT score was 101 cells/L, 76.0 %, 24. On August 2022, eosinophil count increased, but the Lund-Mackay, the SNOT-22, Question 21/22 score decreased. The second patient, a 45-year-old woman, diagnosed with aspirin-exacerbated respiratory disease (AERD), started dupilumab on August 2020. The Lund-Mackay, the SNOT-22, Question 21/22 score was 15, 22, 5, 3. On August 2022, all of the Lund-Mackay, the SNOT-22, Question 21/22 score decreased. The third patient, diagnosed with AERD, started dupilumab on September 2020. Eosinophil count, FEV1 (%), the ACT score was 75 cells/L, 74.4 %, 25. The Lund-Mackay, SNOT-22, Question 21/22 score was 5, 41, 5, 3. On August 2022, eosinophil count increased, and FEV1 (%), the ACT score decreased. The Lund-Mackay, the SNOT-22 score decreased, but Question 21/22 remained at the same. The fourth patient, a 32-year-old man, started dupilumab on April 2022. On July 2022, manifestations of CRS was improved, but eosinophil count increased. Sputum induction showed eosinophilia. Dupilumab was stopped, and he was given oral prednisone with a remarkable symptomatic improvement.

Keywords: Asthma Control Test, blood eosinophil count, forced expiratory volume in 1 second, Lund-Mackay score, Sino-Nasal Outcome Test-22.