Olfactory outcomes with dupilumab in chronic rhinosinusitis with nasal polyps

ABSTRACT BACKGROUND Loss of smell is one of the most troublesome and difficult-to-treat symptoms of severe chronic rhinosinusitis with nasal polyps (CRSwNP). OBJECTIVE To assess the impact of dupilumab on sense of smell in severe CRSwNP. METHODS In the randomized SINUS-24 and SINUS-52 studies, adults with severe CRSwNP received dupilumab 300 mg subcutaneously or matching placebo every 2 weeks for 24 or 52 weeks, respectively. Smell was assessed using daily patient-reported loss of smell (LoS) score (0–3) and University of Pennsylvania Smell Identification Test (UPSIT; 0–40). Data from the two studies were pooled through Week 24. Relationships between patient phenotypes and smell outcomes were also assessed. RESULTS 724 patients were randomized (286 placebo, 438 dupilumab); mean CRSwNP duration was 11 years; 63% had prior sinonasal surgery. Mean baseline LoS was 2.74. Dupilumab produced rapid improvement in LoS, evident by Day 3, which improved progressively throughout the study periods (least squares [LS] mean difference versus placebo −0.07 [95% CI −0.12, −0.02]; nominal P CONCLUSIONS Dupilumab produced rapid and sustained improvement in sense of smell, alleviating a cardinal symptom of severe CRSwNP.