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Rosso C, De Corso E, Conti V, Nitro L, Saibene AM, Parazzini E, Rinaldo R, De Pascalis S, Arnone F, Centanni S, Montuori C, D'Auria LM, Felisati G, Pipolo C. Switching of biological therapy to dupilumab in comorbid patients with severe asthma and CRSwNP. Eur Arch Otorhinolaryngol 2024; 281:3017-3023. [PMID: 38347197 PMCID: PMC11065938 DOI: 10.1007/s00405-024-08461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/07/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Nowadays, several efficacious biologic drugs are used for severe asthma with or without chronic rhinosinusitis with nasal polyps (CRSwNP). However, it has been observed that not all comorbid patients (asthma/CRSwNP) receiving biologic treatment for asthma experience satisfactory control of both conditions equally. METHODS We selected 20 patients who had both severe asthma and comorbid CRSwNP under biological treatment with benralizumab, omalizumab or mepolizumab with adequate control of asthma but inadequate control of nasal symptoms. Patients were switched to dupilumab and outcomes were evaluated at baseline (T0), at 3 months (T1), at 6 months (T2), at 12 months (T3) and finally at 18 months (T4). Data were collected at each time point including blood tests measuring eosinophil levels and total IgE, SNOT22, ACT, NPS score, rhinomanometry, olfactory testing, and nasal cytology. RESULTS The results showed an overall improvement in all the outcomes. Peripheral eosinophilia was observed consistently with existing literature. All patients registered an improvement in sinonasal outcomes, while only one patient had a worsening of asthma. Three patients interrupted the therapy due to various causes: poor asthma control, onset of psoriasis and thrombocytopenia. CONCLUSIONS The response to a biologic treatment for CRSwNP control may be heterogenous and it seems that patients may benefit from switching improving control in equal measure in the upper and lower airway. Further studies to explore the endotype/phenotype which best fits with each biologic are mandatory to personalize the therapy.
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Affiliation(s)
- Cecilia Rosso
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
- Department of Otolaryngology, San Paolo Hospital, University of Milan, via di Rudinì 8, 20154, Milan, Italy.
| | - Eugenio De Corso
- Unit of Otorhinolaryngology-Head and Neck Surgery, A. Gemelli Hospital Foundation IRCCS, 00168, Rome, Italy
| | - Valerio Conti
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Letizia Nitro
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Elena Parazzini
- Pulmonology Department, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Rocco Rinaldo
- Pulmonology Department, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Sabrina De Pascalis
- Pulmonology Department, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Flavio Arnone
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Stefano Centanni
- Pulmonology Department, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Claudio Montuori
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Leandro Maria D'Auria
- Department of Head-Neck and Sensory Organs, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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Galassi A, Casanova F, Gazzola L, Rinaldo R, Ceresa M, Restelli E, Giorgini A, Birocchi S, Giovenzana M, Zoni U, Valli F, Massironi L, Belletti S, Magagnoli L, Stucchi A, Ippolito M, Carugo S, Parazzini E, Cozzolino M. SARS-CoV-2-related ARDS in a maintenance hemodialysis patient: case report on tailored approach by daily hemodialysis, noninvasive ventilation, tocilizumab, anxiolytics, and point-of-care ultrasound. Clin Case Rep 2021; 9:694-703. [PMID: 33362933 PMCID: PMC7753751 DOI: 10.1002/ccr3.3623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022] Open
Abstract
Without rescue drugs approved, holistic approach by daily hemodialysis, noninvasive ventilation, anti-inflammatory medications, fluid assessment by bedside ultrasound, and anxiolytics improved outcomes of a maintenance hemodialysis patient affected by severe COVID-19.
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Affiliation(s)
- Andrea Galassi
- Renal & Dialysis UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Francesca Casanova
- Internal Medicine UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Lidia Gazzola
- Department of Health SciencesClinic of Infectious Disease“San Paolo” Hospital‐University of MilanMilanItaly
| | - Rocco Rinaldo
- Respiratory UnitDepartment of Health SciencesUniversity of MilanASST Santi Paolo e CarloMilanItaly
| | - Marco Ceresa
- Palliative Care UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Elena Restelli
- Internal Medicine UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Alessia Giorgini
- Gastroenterology and Hepatology UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Simone Birocchi
- Internal Medicine UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Marco Giovenzana
- Unit of Hepatobiliary, Pancreatic, and Digestive SurgeryDepartment of SurgeryS. Paolo HospitalUniversity of MilanMilanItaly
| | - Ulisse Zoni
- Internal Medicine UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Federica Valli
- Division of CardiologyS. Paolo HospitalUniversity of MilanMilanItaly
| | - Laura Massironi
- Division of CardiologyS. Paolo HospitalUniversity of MilanMilanItaly
| | | | - Lorenza Magagnoli
- Renal & Dialysis UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Andrea Stucchi
- Renal & Dialysis UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Michela Ippolito
- Renal & Dialysis UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Stefano Carugo
- Division of CardiologyS. Paolo HospitalUniversity of MilanMilanItaly
| | - Elena Parazzini
- Respiratory UnitDepartment of Health SciencesUniversity of MilanASST Santi Paolo e CarloMilanItaly
| | - Mario Cozzolino
- Renal & Dialysis UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
- Department of Health SciencesUniversity of MilanMilanItaly
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