Dupilumab Found to Significantly Improve Sense of Smell in Patients With CRS With Nasal Polyps

Dupilumab treatment was associated with significantly reduced anosmia prevalence among patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and smell impairment. Findings were reported at the 2022 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting and are published in The Journal of Allergy and Clinical Immunology.

It is estimated that 60% to 80% of patients with CRSwNP have olfactory dysfunction, which has been linked with physical and social alterations that impair quality of life.

Prior results of the LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52 phase 3 trials showed that dupilumab treatment improved sense of smell in patients with CRSwNP, and researchers sought to further examine olfactory outcomes in patients of the 52-week trial.

They conducted a post hoc analysis of SINUS-52, in which patients were randomly assigned to dupilumab 300 mg every 2 weeks for 52 weeks (n = 136) or placebo (n = 146).

Patients with baseline smell impairment were analyzed, which was identified by a loss of smell score greater than or equal to 1 (mild), a University of Pennsylvania Smell Identification Test (UPSIT) score of greater than or equal to 34 for women and greater than or equal to 33 for men, and a very mild or greater problem in decreased sense of smell/taste identified by the 22-item sino-nasal outcome test (SNOT-22).

“Change from baseline in nasal polyp score (NPS, 0-8)/nasal congestion (NC, 0-3)/SNOT-22 (0-110) was reported in patients with anosmic (UPSIT 0-18) and normosmic (UPSIT > 34/ > 33 [women/men]) CRSwNP at week 52,” noted researchers.

At baseline, prevalence of anosmia was reported in 81.6% and 77.4% of patients with CRSwNP given dupilumab and placebo, respectively. Findings at week 52 showed a marked reduction in the proportion of patients with anosmia treated with dupilumab (29.2%), with a further 11.5% of patients reporting a normal sense of smell (normosmia).

Conversely, prevalence of anosmia was largely unchanged among patients with CRSwNP treated with placebo (76.8%), with none reporting normosmia.

Greater mean (SD) changes from baseline in NPS/NC/SNOT-22 were also observed in patients reporting normosmia vs anosmia with dupilumab at week 52:

• NPS (normosmia, −3.57 [1.77]; anosmia, −1.16 [1.79])
• NC (normosmia, −1.68 [0.59]; anosmia, −0.82 [0.84])
• SNOT-22 (normosmia, −29.73 [11.44]; anosmia, −16.79 [19.15])

“Greater improvements in NPS, NC and SNOT-22 were observed in dupilumab-treated patients reporting better olfactory outcomes at week 52, which may have contributed to their improved olfaction,” noted researchers.

Reference

Mullol J, Hopkins C, Fokkens W, et al. Dupilumab leads to reduction of anosmia in patients with severe chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. Published online February 1, 2022. doi:10.1016/j.jaci.2021.12.486