Chronic rhinosinusitis is a long-lasting medical condition, usually caused by infection or exposure to irritants, such as allergies, that affects one in seven American adults. Symptoms include nasal obstruction, nasal congestion, nasal drainage, loss of smell and taste, and facial pain and pressure. Some people with chronic rhinosinusitis also develop additional symptoms, such as asthma and nasal polyps, that are exacerbated by underlying allergies. A nasal polyp is a noncancerous tumor that grows from the lining of the nose or sinuses and affects the drainage system of the sinuses.
While chronic rhinosinusitis is not a life-threatening condition, the chronic nature and progression of the disease can have a significant impact on quality of life, affecting work, productivity, and sleep, and leading to social and emotional consequences, such as depression and anxiety.
Recently, a new medication has been approved in the treatment of chronic rhinosinusitis with nasal polyps.
What is the new medication and how would it be used?
Current treatment includes a combination of therapies that target symptoms. These include medical and surgical treatments, such as antibiotics, short-term oral corticosteroids, steroid nasal sprays, sinus irrigation, and endoscopic sinus surgery. However, many people continue to experience symptoms despite treatment.
Earlier this year, the FDA approved dupilumab (Dupixent) to treat chronic rhinosinusitis with nasal polyps that is not adequately controlled with standard treatment. It is intended to be used together with the other established treatments.
Dupilumab is a human-derived monoclonal antibody, a type of drug that enlists the body’s immune system to help it do its job. It specifically inhibits IL-4 and IL-13 cytokines, chemicals involved in the inflammatory allergic response that leads to symptoms. It is given by injection, under the skin, every other week. It can be administered in a doctor’s office or self-administered at home.
Several clinical trials, including this study published in JAMA (and funded by the drug’s manufacturer), have looked into the effects of dupilumab on chronic rhinosinusitis with nasal polyps. In the JAMA study, participants received either dupilumab plus a steroid nasal spray or a placebo plus a steroid nasal spray, for 16 weeks. Those treated with dupilumab had significant improvements in nasal congestion and obstruction, sense of smell, and overall decreased need for oral corticosteroids and surgery. In those study participants who also had asthma, lung function improved. There were also reductions in nasal polyp size and improved appearance of the sinuses on imaging studies. Patients experienced improvement of symptoms as early as four weeks into treatment, and continued to experience greater improvement than the placebo group for up to one year.
Dupilumab is not a cure for chronic rhinosinusitis with nasal polyps. However, it is an exciting advancement in the treatment of a chronic condition that significantly impacts physical and emotional health.
How do I know if I have chronic rhinosinusitis with nasal polyps and if I am a candidate for dupilumab?
Chronic rhinosinusitis is commonly diagnosed by a primary care physician who can then refer you to an otolaryngologist, or ear, nose, and throat (ENT) physician, for specialty care. The ENT may perform a nasal endoscopy exam and recommend additional testing, such as imaging studies, to make the diagnosis of chronic rhinosinusitis with nasal polyps. Depending on the treatments you have tried, the ENT will assess whether you are an appropriate candidate for dupilumab.