Dr. Ahmed
Chronic sinusitis, also known as chronic rhinosinusitis, is an inflammatory condition that affects the paranasal sinuses, leading to nasal blockage, congestion, and nasal discharge.
Chronic sinusitis has two types, with nasal polyps or without them. Sadly, chronic sinusitis with nasal polyps becomes highly bothersome because of additional symptoms associated with the polyps.
Together, these conditions go beyond just a simple cold, and the constant congestion leads to breathing difficulties and disturbed sleep. Moreover, it highly impacts your daily activities.
Dupixent (Dupilumab) is an emerging medication for the treatment of chronic sinusitis with nasal polyps.
The FDA has approved Dupixent (Dupilumab) for treating chronic sinusitis accompanied by nasal polyps.
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What Causes Chronic Sinusitis?
Type 2 inflammation involves T-helper cells that release chemicals like interleukins which play a role in mucus production.
In chronic sinusitis, this inflammatory response gets triggered even in the absence of an actual threat.
As a result, there is uncontrolled mucus production, which leads to congestion and blockage. All this triggered response further produces proteins that lead to the formation of nasal polyps.
Although underlying inflammation is the usual cause, other causes include:
- Structural abnormality of the nose and sinuses that cause drainage problems.
- Cystic fibrosis that genetically affects mucus production and its consistency.
- Reaction to anti-inflammatory drugs like NSAIDs.
- Weakened immune system.
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How Dupixent Treats Chronic Sinusitis and Nasal Polyps?
Dupixent targets inflammatory markers that lead to type 2 inflammation. Moreover, it blocks differentiation in type 2 inflammatory cells and inhibits the production of IgE.
As it specifically targets these markers, dupilumab treatment significantly decreases the levels of IL-4, IL-13, pulmonary chemokines, and eosinophilic proteins.
Serum levels of thymus and activation-regulated chemokines (TARC) that are involved in chronic sinusitis are also reduced by Dupixent therapy.
Studies have shown that dual blockage of IL-4 and IL-13 is required to prevent eosinophil entry into the lung tissue. [Ref]
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Is Dupixent a Better Treatment Option?
Chronic sinusitis with nasal polyps has a chance of recurrence even after the endoscopic sinus surgery, and the main reason for these relapses is recurrent type 2 inflammation.
While Dupixent is not the ultimate best solution, it is a highly effective treatment option.
According to a retrospective study, it was reported that in 75 patients with chronic rhinosinusitis with nasal polyps, dupilumab therapy showed greater efficacy and was also associated with better outcomes as compared to traditional treatments and surgery. [Ref]
Another study exploring the efficacy of dupilumab concluded that its use decreased the need to try additional medications like intranasal corticosteroids and significantly decreased the number of sinus surgeries.
A similar study reported that dupilumab was well tolerated with mild side effects like injection site reactions. Conjunctivitis, keratitis, nasopharyngitis, and arthralgia. [Ref]
Meanwhile, a multicenter study’s findings confirm that dupilumab use reduces polyp size and sinus opacification and improves overall quality of life in patients with severe chronic rhinosinusitis with nasal polyps. [Ref]
Although dupilumab is a good treatment option, it is still recommended to be used for moderate to severe cases and not for milder ones.
Moreover, Dupixent is overall a better treatment option as it ensures a steroid-free treatment with promising results.
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Traditional Treatments of Chronic Sinusitis and Nasal Polyps:
Other commonly used treatment options include:
Nasal and Oral Corticosteroids
These include nasal sprays like Flonase, Rhinocort, and Nasonex, which reduce inflammation but come with greater side effects. Often, the relief is temporary.
Nasal Decongestants
Decongestants like oxymetazoline and phenylephrine help with congestion, but overuse can also worsen congestion and cause dryness and irritation.
Saline Irrigation
This is a process that involves flushing saline water into the nasal passages. It clears mucus, removes irritants, and provides a temporary soothing effect. However, the underlying issues remain the same.
Surgery
Surgery can be helpful to remove nasal polyps. However, if the underlying inflammation is not managed, polyps can reoccur, which often requires another surgery.
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Comparing Dupixent vs Traditional Treatment for Chronic Sinusitis and Nasal Polyps
Characteristics | Dupixent | Other Treatments |
| Mode of action | Aims to inhibit the action of interleukins involved in type 2 inflammation. | Most corticosteroids aim to reduce inflammation for a short period of time. Decongestants only help with nasal congestion. |
| Effectiveness | Highly effective in reducing polyp size, decongestion, and overall symptom reduction. | Can be effective, but often the relief is temporary. |
| Long-term safety | Long-term data is insufficient | Long-term use is associated with greater side effects |
| Cost and convenience | Expensive, requires injections | Less expensive and easier to administer |
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Common Side Effects of Dupixent for Nasal Polyps and Sinusitis:
Patients with chronic sinusitis and nasal polyps can experience the following side effects after using Dupixent:
- Breathing problems
- Increased heart rate
- Hives
- Nausea
- Dizziness and fatigue
- Joint pain
- Eye infections like conjunctivitis, keratitis, etc.
- Injection site reactions
- Toothache
Conclusion
Dupixent is a promising treatment for chronic sinusitis and nasal polyps. By specifically targeting the pro-inflammatory chemicals, this medication offers a new level of control, greater symptom relief, and improved quality of life.
