Clin Exp Otorhinolaryngol.  2024 Nov;17(4):317-325. 10.21053/ceo.2024.00233.

Therapeutic Effectiveness of SNOT 22-Based Interdose Interval Adjustment of Dupilumab for Chronic Rhinosinusitis With Nasal Polyps

• Yoon SY
• Cha H
• Hong SN
• Yang MS
• Kim DW

• KMID: 2561365
• DOI: http://doi.org/10.21053/ceo.2024.00233

Abstract

Objectives
. This study evaluates the enduring efficacy and patient satisfaction of dupilumab with interdose interval adjustments based on the Sino-Nasal Outcome Test (SNOT-22) in chronic rhinosinusitis with nasal polyps (CRSwNP).
Methods
. A retrospective analysis was conducted on 44 patients who had been treated with dupilumab for over 6 months. This study targeted individuals diagnosed with CRSwNP according to the 2020 edition of the European Position Paper on Rhinosinusitis and Nasal Polyps Criteria. The treatment involved an add-on dupilumab regimen, where the interdose interval was adjusted based on the SNOT-22 scores. Dosage adjustments were made such that patients with initial SNOT-22 scores greater than 40 were tapered to a target level of 20 or less. Similarly, for patients with initial scores of 40 or less, the treatment aimed for an improvement of 50% or more. At each visit, the effectiveness of the treatment was evaluated using SNOT-22, nasal polyp scores (NPS), and a subjective satisfaction questionnaire adapted from the Treatment Satisfaction Questionnaire for Medication (TSQM v.1.4).
Results
. The adjustment of the interdose interval for dupilumab based on SNOT-22 scores demonstrated sustained improvements in patients’ subjective symptoms, satisfaction, and NPS. The mean (standard deviation) SNOT-22 scores significantly decreased from 46.04 (22.30) to 14.72 (13.66) over 6 months (P<0.001). Similarly, NPS scores improved from 3.20 (2.24) to 1.72 (1.46) within the same period (P<0.001). Satisfaction scores, ranging from 0 to 5, consistently remained above 3.5 for up to 6 months (P=0.166). Additionally, there was a significant correlation between the improvement in the nasal symptom domain of the SNOT-22 scores and higher satisfaction scores.
Conclusion
. Adjusting dupilumab dosing intervals based on SNOT-22 scores from the outset resulted in sustained efficacy and patient satisfaction in Korean patients with CRSwNP. This approach will meaningfully assist clinicians in determining the optimal dupilumab dosing interval.

Keyword

Biological Therapy; Rhinosinusitis; Nasal Polyps; Dupilumab; Symptom Assessment; Surveys and Questionnaires

Figure

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  Fig. 1. Examples of interdose interval adjustment. SNOT-22, Sino-Nasal Outcome Test.

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  Fig. 2. Progression of tapering dupilumab.

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  Fig. 3. Sustained improvement during tapering periods: (A) Sino-Nasal Outcome Test (SNOT-22), (B) olfaction (visual analog scale), and (C) nasal polyp score. ***P<0.001.

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  Fig. 4. Sustained satisfaction scores during tapering periods: (A) symptomatic satisfaction, (B) global satisfaction, (C) convenience, (D) adverse events, (E) preference, (F) willingness to continue, and (G) willingness to recommend. NS, not significant.

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