D1.159 - The successful resolve of nasal polyps in patient with dupilumab treatment

Currently, the issue of frequent relapses of rhinosinusitis in patients with nasal polyps (CRSwNP) holds significance. Among the causes of occurrence are allergies and frequent relapses of infection, and the corresponding genetic predisposition to the development of polyps. The surgical treatment of CRSwNP remains optimal today, but the frequency of relapses forces us to take a personalized approach with biological agents. In patients with an eosinophilic phenotype of polyps, it is recommended to use IL -4 blockers or Il -5. Less anti- IgE are effective agents such as omalizumab. This publication highlights a patient with CRSwNP who previously underwent surgical treatment with the removal of nasal polyps three times. However, nasal congestion persisted, polyps recurred again, and the patient's quality of life was impaired. From the clinical history, it was known that the patient was sensitized to house dust mites, cat and dog epidermis, and ragweed. The level of common immunoglobulin E was 570 IU/ml, and blood eosinophilia was 560 cells/μl. After a 3-year course of AIT with house dust and ragweed allergens, a slight improvement was noted, manifested in a decrease in seasonal exacerbations of rhinitis. However, polyp recurrences continued, and the patient's quality of life deteriorated. Thus, the patient was prescribed a course of dupiplumab. Initially, a loading dose of 600 mg was administered, then we used 300 mg of dupilumab monthly for 6 months. After the course of treatment, the patient had complete resolution of polyps without surgical treatment, a decrease in the level of blood eosinophils and total immunoglobulin E, improved quality of life, and normalized sleep. We have observed such a case of complete disappearance of polyps without surgical treatment in our clinical practice for the first time. Therefore, based on the results of our clinical observation, we can conclude that patients with frequent recurrences of nasal polyps require assessment of the polyp phenotype and personalized selection of target biological therapy. However, not all patients achieve remission or complete resolution of polyps.