ASSOCIATION BETWEEN SMELL LOSS, DISEASE BURDEN, AND DUPILUMAB EFFICACY IN CHRONIC RHINOSINUSITIS WITH NASAL POLYPS

• Published in: Annals of allergy, asthma, & immunology Vol. 129; no. 5; p. S72
• Main Authors: Soler, Z., Lane, A., Patel, Z., Mattos, J., Xia, C., Khan, A., Nash, S.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.11.2022
• ISSN: 1081-1206; 1534-4436
• DOI: 10.1016/j.anai.2022.08.709

This post-hoc analysis investigated the association between baseline smell loss and other aspects of disease in chronic rhinosinusitis with nasal polyps (CRSwNP), and evaluated the effects of dupilumab according to severity of baseline smell loss in the pooled SINUS-24 and SINUS-52 studies (NCT02912468, NCT02898454). Nasal polyp score (NPS, 0−8), patient-reported nasal congestion/obstruction (NC, 0−3), and 22-Item Sinonasal Outcome Test (SNOT-22, 0−110) were analyzed according to baseline monthly average patient-reported loss of smell scores (LoS, 0−3) of >1−≤2 (moderate) or >2−≤3 (severe) in patients randomized to dupilumab 300 mg or placebo every 2 weeks. A total of 724 patients were randomized. Baseline LoS was severe in 601 patients (83%) and moderate in 106 patients (15%). At baseline, odds ratios (95% CI) for severe vs moderate LoS were 1.12 (0.96, 1.32) with 1-point increase in NPS, 6.01 (3.95, 9.15) with 1-point increase in NC, 1.03 (1.02, 1.05) with 1-point increase in SNOT-22, and 3.01 (1.97, 4.59) for with vs without prior sinonasal surgery. At Week 24, least squares mean differences (95% CI) dupilumab vs placebo in change from baseline were: NPS −1.90 (−2.56, −1.25) and −1.95 (−2.20, −1.70) in the moderate and severe baseline LoS subgroups, respectively; NC −0.35 (−0.64, −0.06) and −1.00 (−1.13, −0.87); and SNOT-22 −7.52 (−14.55, −0.48) and −21.72 (−24.63, −18.82); all nominal P <0.05 vs placebo. Increased severity of loss of smell is associated with greater disease burden in CRSwNP. Dupilumab significantly improved outcomes and HRQoL regardless of baseline severity of smell loss.