D1.388 - Aspirin maintenance after boost with dupilumab in aspirin-exacerbated respiratory disease

Aspirin-exacerbated respiratory disease (AERD) combines asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), and NSAID hypersensitivity. Nasal polyps often drive repeated surgeries. Aspirin desensitization sometimes sustains remission. Dupilumab, though effective for CRSwNP, faces access barriers. A sequential strategy was assessed with  dupilumab initiation followed by aspirin desensitization and maintenance.

In this real-world study, 12 AERD patients received 2-4 initial dupilumab doses (300 mg). Thereafter, six discontinued dupilumab (Group 1) due to cost, continuing on standard care. Six underwent aspirin desensitization and maintained daily aspirin dose of 400 mg for  months  (Group 2). Subjective symptoms (visual analogue scale, VAS), lung function (FEV1), fractional exhaled nitric oxide (FeNO), and eosinophil cationic protein (ECP) were assessed at baseline and at six months.

All patients improved after the initial dupilumab doses: VAS decreased from 7.3±0.3 to 4.6±0.5 (mean±SEM, p=0.001); FEV1 % predicted increased from 69.5±4.5 to 97.8±3.6 (p=0.001); FeNO ppb: decreased from 59,0±7.2 to 42.3±3.9 (p=0.049); ECP ng/mL: decreased from 26.2±4.6 to 19,58±5.1 (p=0.161). At six months, FEV1 was better preserved in Group 2 (aspirin maintenance) versus Group 1 (95.2±2.1 vs. 85.4±3.8, p=0.033). Biomarker changes (FeNO, ECP) were not statistically significant due to the  small number of subjects.

An initial short-course dupilumab "boost" followed by aspirin maintenance therapy appears feasible and may preserve lung function improvements, offering a potential pragmatic strategy for AERD management.