Effects of dupilumab on nasal mucociliary clearance in severe CRSwNP: evaluation of the saccharin test as an objective outcome measure

Abstract

OBJECTIVE: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic, relapsing condition associated with a significant impairment in quality of life. Persistent inflammation contributes to dysfunction of mucociliary clearance. Dupilumab (IL-4Rα inhibitor) is a well-established therapeutic agent that has demonstrated significant efficacy in reducing type 2 inflammation and improving quality of life in patients with severe CRSwNP refractory to medical and/or surgical treatment. This study aimed to evaluate whether dupilumab therapy improves mucociliary clearance in patients with CRSwNP. METHODS: Twenty-one patients with severe CRSwNP were enrolled. All received dupilumab (300 mg subcutaneously every 2 weeks) according to prescribing criteria. At baseline and after 4, 8, and 12 weeks, patients underwent evaluation with SNOT-22, nasal endoscopy with Nasal Polyp Score (NPS), and assessment of mucociliary clearance using the saccharin test (ST). Nasal mucociliary clearance time (NMCT) values were compared across time points.. RESULTS: Significant improvements were observed in SNOT-22, NPS, and NMCT. Mean NMCT values measured using the ST values decreased from 14.3 minutes at baseline to 10.1 minutes at 4 weeks (p<.01), 7.75 minutes at 8 weeks, and 5.84 minutes at 12 weeks, indicating a progressive and statistically significant enhancement of mucociliary clearance. CONCLUSIONS: Short-term dupilumab therapy was associated with a significant improvement in nasal mucociliary clearance in patients with severe CRSwNP. These preliminary findings support the potential role of the saccharin test as a simple, objective tool for monitoring response to biologic therapy.