Dupilumab in the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP): A multicentric observational Phase IV real-life study (DUPIREAL)

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with significant morbidity and reduced health-related quality of life. Findings from clinical trials have demonstrated the effectiveness of dupilumab in CRSwNP, although real-world evidence is still limited.

METHODS

This Phase IV real-life, observational, multicenter study assessed the effectiveness and safety of dupilumab in patients with severe uncontrolled CRSwNP (n = 648) over the first year of treatment. We collected data at baseline and after 1, 3, 6, 9, and 12 months of follow-up. We focused on nasal polyps score (NPS), symptoms, and olfactory function. We stratified outcomes by comorbidities, previous surgery, and adherence to intranasal corticosteroids, and examined the success rates based on current guidelines, as well as potential predictors of response at each timepoint.

RESULTS

We observed a significant decrease in NPS from a median value of 6 (IQR 5-6) at baseline to 1.0 (IQR 0.0-2.0) at 12 months (p < .001), and a significant decrease in Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score of 58 (IQR 49-70) at baseline to 11 (IQR 6-21; p < .001) at 12 months. Sniffin' Sticks scores showed a significant increase over 12 months (p < .001) compared to baseline. The results were unaffected by concomitant diseases, number of previous surgeries, and adherence to topical steroids, except for minor differences in rapidity of action. An excellent-moderate response was observed in 96.9% of patients at 12 months based on EPOS 2020 criteria.

CONCLUSIONS

Our findings from this large-scale real-life study support the effectiveness of dupilumab as an add-on therapy in patients with severe uncontrolled CRSwNP in reducing polyp size and improving the quality of life, severity of symptoms, nasal congestion, and smell.

[Food Security in Europe: comparison between the "Hygiene Package" and the British Retail Consortium (BRC) & International Food Standard (IFS) protocols]

The birth of Hygiene Package and of the Reg. CE no 2073/2005 in the food production field signalled a change in Italy. This process started in Italy in 1997 with the legislative decree no 155 on Self-control but in reality, it was implemented in the UK in 1990 with the promulgation of the Food Safety Act. This legal act was influenced by some basic rules corresponding to the application of HACCP standards. Since 1990 the British chains of distribution (Retailers) have involved all aspects of the food line in this type of responsibility. Due to this growing awareness for a need for greater regulation, a protocol, edited by British Retail Consortium was created in 1998. This protocol acted as a "stamp" of approval for food products and it is now known as the BRC Global Food Standard. In July 2008, this protocol became effective in its fifth version. After the birth of BRC, also French and German Retailers have established a standard practically equivalent and perhaps more pertinent to safety food, that is International Food Standard (IFS). The new approach is specific to the food field and strictly applies criteria which will ensure "safety, quality and legality" of food products, similarly to ISO 22000:2005 (mainly based on BRC & IFS past experiences). New standards aim to create a sort of green list with fully "proper and fit" Suppliers only, because of comprehensible exigencies of Retailers. It is expected, as we have shown, that Auditor authorities who are responsible for ensuring that inspections are now carried out like the Hygiene Package, will find these new standards useful. The advantages of streamlining this system is that it will allow enterprises to diligently enforce food safety practices without fear of upset or legal consequence, to improve the quality (HACCP) of management & traceability system; to restrict wastes, reprocessing and withdrawal of products. However some discordances about the interpretation of certain sub-field norms (e.g., water management) are evident and should be carefully discussed once more.

Ropivacaine induced acute neurotoxicity after epidural injection

Ropivacaine is an amide-type long acting local anaesthetic. According to experimental and human data, its toxicity for Central Nervous System (CNS) and Cardiovascular System (CVS) is considered lower than toxicity related to bupivacaine, the now-a-days accepted golden standard for long acting local anaesthetics. Nevertheless, reports about this kind of accidents are fairly numerous. Aim of this short paper is to describe, primarily from a subjective point of view, CNS symptoms a patient (one of the Authors) suffered by an acute toxic reaction during an epidural block, and to stress the need to pay attention to safety measures in the practice of loco-regional anaesthesia and epidural blockade.

A runny nose: an unexpected ferromagnetic foreign body in an unexpected place

A case report about a small child scheduled to undergo brain Magnetic Resonance (MR) imaging first and Computed Tomography (CT) scan next in the same session for coeliachia and possible associate malformative diseases is described. Only by chance the MR procedure has not been carried out, and the CT scan scout view revealed unexpectedly a metallic paper clip deeply embedded in a nasal fossa. The potential of unwelcome side effects and effective safety degree of MR imaging are discussed.