A case of intractable chronic rhinosinusitis without nasal polyps leading remission after treatment switching from anti-IL-5 to anti-IL-4Rα monoclonal antibody

Abstract

Previous studies have demonstrated the efficacy of biologics targeting type 2 inflammation, such as IgE, IL-5, IL-5Rα and IL-4Rα for chronic rhinosinusitis (CRS) with nasal polyps. However, it remains unknown whether these biologics are effective and safe for CRS patients without nasal polyps (CRSsNP), which is another phenotype of CRS. Reports in the literature suggest that CRSsNP pathogenesis is heterogeneous and appears to have shifted to the type 2 inflammatory endotype. The current report presents information on the first intractable CRSsNP case comorbid with asthma that demonstrated resistance to mepolizumab, with switching to dupilumab leading to improvements in not only bronchial and nasal symptoms but also in the sinus computed tomography radiological findings. Moreover, these findings suggest that biologics targeting type 2 inflammation may be a treatment option for intractable type 2 CRSsNP, with signaling through IL-4Rα rather than IL-5 playing a central role in the CRSsNP pathogenesis in this case.