Improving Sense of Smell in Patients with CRSwNP: Results of Two Studies of Dupilumab

Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) may experience a variety of symptoms, including lost sense of smell, which is difficult to manage with existing therapies. The effect of dupilumab on sense of smell in patients with CRSwNP was evaluated in the SINUS-24 and SINUS-52 studies; it was concluded that dupilumab improved sense of smell in patients with severe CRSwNP. A pooled analysis of the results was published as part of the AAAAI Annual Meeting.

In SINUS-24, patients were randomized 1:1 to receive dupilumab 300 mg subcutaneously or placebo every two weeks (q2w) for 24 weeks. In SINUS-52, patients were randomized 1:1:1 to receive dupilumab 300 mg subcutaneous q2w for 52 weeks; dupilumab 300 mg q2w for 24 weeks, then q4w for 28 weeks; or placebo q2w for 52 weeks. Sense of smell was determined per the University of Pennsylvania Smell Identification Test (UPSIT) score (0-40), patient-reported loss-of-smell score (0-3), and decreased-smell/taste score on the Sino-Nasal Outcome Test (0-5).

Sense of smell was impaired at baseline, with a mean UPSIT score of 13.98, loss of smell of 2.74, and decreased smell/taste of 4.28. About three-quarters of patients (77.6%) were anosmic, defined as a UPSIT score ≤18. At week 24, the percentage of anosmic patients on dupilumab decreased to 28.0%, compared with 77.1% in the placebo group. Sense of smell improved in the dupilumab group at week 24 (least squares mean difference versus placebo; all nominal P<0.000); UPSIT score improved by 10.57 points, loss of smell decreased by 1.04 points, and decreased smell/taste decreased by 1.97. Fewer than 5% of patients experienced adverse events (AEs), which were more common in patients receiving placebo. The most common AEs were nasopharyngitis, nasal polyps, headache, injection-site erythema, asthma, and epistaxis.

The researchers concluded that dupilumab improved sense of smell compared with placebo in patients with CRSwNP and was a generally well-tolerated treatment.

https://www.jacionline.org/article/S0091-6749(19)32051-2/fulltext