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Hypereosinophilia management in patients with type 2 chronic rhinosinusitis treated with dupilumab: preliminary results

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Biological therapies are gaining relevance in the management of CRSwNP with few adverse events reported. Among these, dupilumab, an anti-IL4-Ra monoclonal antibody, is frequently associated with hypereosinophilia (HE) which usually remains silent and progressively resolves, although some cases of systemic involvement occurs. The aim of this paper is to describe our experience and propose a management flowchart for HE during therapy with dupilumab.

Methods

Patients with CRSwNP who satisfied EPOS2020 criteria for biological therapies were included in this prospective study. Each case was discussed in a multidisciplinary meeting with subsequent prescription of dupilumab; all patients were candidates to follow-up bi-monthly for 6 months, while additional blood tests were scheduled in the event of HE.

Results

A total of 21 patients with a mean age of 48.4 years were enrolled. Of these, 15 of 21 presented an asthma comorbidity and 9 of 21 ASA sensitivity. Four patients (19%) developed HE with AEC > 1.5 × 109/L, whereas it occurred in 9.5% (two patients) if considered AEC > 3 × 109/L. No cases of hypereosinophilic syndrome were recorded. Following our decision-making flowchart, two patients received short-term corticosteroid therapy, whereas the other two were only eligible for closer follow-up.

Conclusions

During dupilumab therapy, HE may occur and should be considered benign when < 3 × 109/L in the absence of organ involvement. Conversely, in case of HE ≥ 3 × 109/L, an empirical approach with short-term corticosteroid therapy should be considered to debulk the blood from eosinophils and prevent potential organ involvement.

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Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Author notes

  1. Alessandro Vinciguerra and Andrea Rampi are equally contributed as first author.

Authors and Affiliations

  1. Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Alessandro Vinciguerra, Andrea Rampi, Umberto Tanzini, Mario Bussi & Matteo Trimarchi

  2. Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 68, 20100, Milan, Italy

    Alessandro Vinciguerra, Andrea Rampi, Umberto Tanzini, Mario Bussi & Matteo Trimarchi

  3. Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy

    Mona-Rita Yacoub

  4. General Medicine and Advanced Care Unit, All at IRCCS San Raffaele Scientific Institute, Milan, Italy

    Moreno Tresoldi

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  1. Alessandro Vinciguerra
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  2. Andrea Rampi
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Contributions

AV, AR, AMY, UT and MT made substantial contributions to conception, design and acquisition of data, drafted the article, revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; MB and MT made substantial contributions to conception of the data, revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Matteo Trimarchi.

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Vinciguerra, A., Rampi, A., Yacoub, MR. et al. Hypereosinophilia management in patients with type 2 chronic rhinosinusitis treated with dupilumab: preliminary results. Eur Arch Otorhinolaryngol 279, 5231–5238 (2022). https://doi.org/10.1007/s00405-022-07389-5

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