Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2026
Impact of dupilumab on Sino-Nasal Outcome Test-22 (SNOT-22) domains: Focus on the ear.
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Suter Philipp, Greig Robert, Stewart Kirsten, Lipworth Brian J
Аннотация
BACKGROUND: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is frequently associated with otologic symptoms because of Eustachian tube dysfunction. However, the clinical relevance of otologic symptoms in patients with CRSwNP and their response to biologic therapy remains poorly characterized.
OBJECTIVE: To investigate baseline determinants of ear-related symptoms and evaluate the impact of dupilumab treatment.
METHODS: This post-hoc analysis of the Dupilumab In Severe Asthma (DISA) study included 23 adults with CRSwNP and severe uncontrolled asthma. Participants underwent a 12-week treatment with dupilumab followed by a 12-week washout period. Symptom burden was assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22), including domain-specific analyses. Correlations between the ear/face domain, and endoscopic nasal polyp score (NPS), peak nasal inspiratory flow (PNIF), and type 2 biomarkers, were examined.
RESULTS: At baseline, ear/face symptoms were common, with ear fullness representing the principal complaint. At baseline, the ear/face domain correlated with other SNOT-22 domains and patient-reported outcomes, but not with NPS, PNIF, or type 2 biomarkers. In response to dupilumab, all SNOT-22 domains improved (P < .001), including ear-related symptoms. There was a disconnect in terms of improvements in the ear/face domain being associated with nasal symptoms, but not with NPS, PNIF, or type 2 biomarkers. During washout, symptom deterioration was observed across all SNOT-22 domains.
CONCLUSION: Ear-related symptoms are common in CRSwNP and more closely reflect the overall quality-of-life burden than the degree of nasal airway obstruction, as measured by NPS and PNIF, or type 2 biomarkers. Dupilumab significantly improved these symptoms, with relapse after washout suggesting a link to type 2 inflammation. These findings support that otologic symptoms are important in CRSwNP assessment and management.
OBJECTIVE: To investigate baseline determinants of ear-related symptoms and evaluate the impact of dupilumab treatment.
METHODS: This post-hoc analysis of the Dupilumab In Severe Asthma (DISA) study included 23 adults with CRSwNP and severe uncontrolled asthma. Participants underwent a 12-week treatment with dupilumab followed by a 12-week washout period. Symptom burden was assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22), including domain-specific analyses. Correlations between the ear/face domain, and endoscopic nasal polyp score (NPS), peak nasal inspiratory flow (PNIF), and type 2 biomarkers, were examined.
RESULTS: At baseline, ear/face symptoms were common, with ear fullness representing the principal complaint. At baseline, the ear/face domain correlated with other SNOT-22 domains and patient-reported outcomes, but not with NPS, PNIF, or type 2 biomarkers. In response to dupilumab, all SNOT-22 domains improved (P < .001), including ear-related symptoms. There was a disconnect in terms of improvements in the ear/face domain being associated with nasal symptoms, but not with NPS, PNIF, or type 2 biomarkers. During washout, symptom deterioration was observed across all SNOT-22 domains.
CONCLUSION: Ear-related symptoms are common in CRSwNP and more closely reflect the overall quality-of-life burden than the degree of nasal airway obstruction, as measured by NPS and PNIF, or type 2 biomarkers. Dupilumab significantly improved these symptoms, with relapse after washout suggesting a link to type 2 inflammation. These findings support that otologic symptoms are important in CRSwNP assessment and management.