Early-onset Dupilumab Effects in CRSwNP

University of Rochester

Overview

While it is known that Dupilumab has profound effects in patients with CRSwNP, these are often seen months later after treatment initiation; however, in practice, patients often endorse feeling significantly better within days of their first injection. No studies have investigated the molecular basis for such an acute change. This study proposes that specific cytokine changes in phenotype in addition to microbiome and oscillometry effects play a synergistic role in producing this effect.

This is a single center, prospective, controlled pilot study investigating the acute-onset changes across multiple parameters from immunology to microbiome and pulmonary physiology in patients with CRSwNP after receiving initial doses of dupilumab therapy. In total, eligible participants will be enrolled in the study for a total of 3 weeks, during which they will receive two injections of 300 mg of dupilumab. There will be a total of 8 study visits with the 1st visit being a 1-month pre-intervention baseline allowing each patient to serve as independent controls. The next seven visits will be at the following time points: Day of the 1st injection, 24-hrs after the first injection, 48 hrs after the first injection, one week after the first injection, two weeks after the first injection prior to receiving the second injection, 24hrs after receiving the 2nd injection and the 3-week timepoint (1 week after the second injection). At each visit, patients will be screened for side effects and nasal endoscopy will be performed as well as collection of nasal secretions via sinus packings that are placed in both nares for five minutes. The packings will subsequently be removed and per the collection protocol will undergo centrifugation, aliquoting and storage in a -80 freezer for future cytokine analysis via ELISA assays for various cytokine markers of type 2 inflammation, neutrophil activity, and mucin type. At specific visits, additional measures will be collected including Staph Aureus swabs for qPCR and cell culture, SNOT-22 surveys and smell testing, and oscillometry.

Study Type

INTERVENTIONAL

Allocation

Purpose

BASIC_SCIENCE

Masking

NONE

Conditions

Chronic Rhinosinusitis With Nasal Polyps

Interventions

DupilumabDRUG

Two injections of 300mg dupilumab, subcutaneous 14 days apart

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients age 18+ * who in normal clinical practice would be a candidate for dupilumab. * with a diagnosis of CRSwNP including * at least 2 of the following symptoms on screening: * nasal blockade/obstruction/congestion or nasal discharge; * facial pain/pressure; * reduction or loss of smell Exclusion Criteria: * \> 80 years of age * prior history of immunotherapy use (including prior participation in dupilumab or other clinical trials) * Treatment with systemic corticosteroids, monoclonal antibodies, immunosuppressive treatments or anti-IgE therapy during the past two months prior to trial participation. * CRS without polyps or another non-nasal polyposis condition * Patients with conditions/concomitant diseases making them ineligible for evaluation of the primary efficacy endpoint such as: acute sinusitis/nasal infection or upper respiratory infection at day of screening or in the two weeks prior to screening, Churg-Strauss syndrome, Young's syndrome, Kartagener's syndrome or dyskinetic ciliary syndromes, concomitant cystic fibrosis, CT scan suggestive of allergic fungal rhinosinusitis * Patients with comorbid asthma if they had a recent asthma exacerbation requiring systemic (oral and/or parenteral) steroid treatment or hospitalization for \>24h for treatment of asthma, within 3 months prior to screening or are on a dose of greater than 1000 ug fluticasone or an equivalent inhaled corticosteroid.

Locations (1)

University of Rochester Department of Otolaryngology Head and Neck Surgery

Rochester, New York, United States

Outcomes

Primary Outcomes

Mean change in concentration of IgE (IU/mL)

Determined by output from ELISA assays using antibody against IgE measured as mean change from baseline (IU/mL). Analysis will be performed as mean change from baseline.

Time frame: 3 weeks post baseline

Secondary Outcomes

Mean change in concentration of type II inflammatory markers contributing to sinonasal inflammation (ng/mL)

Determined by output from ELISA assays using antibody against downstream markers of the IL-4/IL-13 cascade, as well as antibodies against markers of neutrophil activity and mucin types that may be altered with dupilumab treatment. Reported as mean change from baseline (pg/ml or ng/ml)

Time frame: 3 weeks post baseline

Mean change in concentration of markers of neutrophil activity contributing to sinonasal inflammation (ng/mL)

Time frame: 3 weeks post baseline

Mean change in concentration of markers of mucin type contributing to sinonasal inflammation (ng/mL)

Time frame: 3 weeks post baseline

Mean change in active Staph Aureus collected via nasal swabs

Determined objectively by mean change in log output from qPCR assays as changes in rCFU/cm2

Time frame: 3 weeks

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.