Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) patients treated with dupilumab may experience an increase in blood absolute eosinophil count (AEC). However, onset and temporal pattern of dupilumab-induced blood eosinophilia (DIBE) have not been thoroughly investigated in real life. Objective: To evaluate DIBE prevalence and temporal pattern in CRSwNP patients, to determine associations between DIBE and adverse events (AEs), patients' clinical characteristics and treatment outcomes. Methods: This is a multicentric historical prospective observational study conducted across 14 Italian centres of DUPIREAL network. DIBE onset and temporal pattern, clinical characteristics, CRSwNP outcomes and AEs were analyzed. DIBE was defined as AEC 50% increased from baseline and at least >500 cells/mm3 or AEC >1500 cells/mm3. Results: A total of 564 CRSwNP patients were enrolled. Mean AEC peaked at 3 months and declined by 12 months. Among patients developing DIBE (48.2%), three distinct temporal patterns were identified basing on onset and duration: early-onset temporary (group 1, 30.7% patients), early-onset persistent (group 2, 14.4% patients), and late-onset (group 3, 3.2% patients). Asthma prevalence (p<0.001), use of asthma inhalers (p<0.001) and previous oral corticosteroid (OCS) use (p<0.045) were greater in patients with DIBE (group 1-3) than in patients without DIBE (group 0). DIBE >1500 cells/mm3 was associated with a higher risk of developing mild AEs (p<0.001). DIBE occurrence did not influence dupilumab outcomes in CRSwNP patients. Conclusion: Distinct DIBE patterns have been identified in CRSwNP patients, based on eosinophilia temporal trends. DIBE was mainly observed in comorbid asthma patients and previous use of systemic steroids. The findings confirm that DIBE is a mostly transient and harmless phenomenon associated only with mild AEs.
De Corso, E., Montuori, C., Pasquini, E., La Mantia, I., Ghidini, A., Pipolo, C., Garzaro, M., Ottaviano, G., Seccia, V., Ciofalo, A., Torretta, S., Cantone, E., Danè, G., Pagella, F., Lucidi, D., Fadda, G. L., Mannocci, A., Cavaliere, C., Pagliuca, G., Canevari, F. R. M., Settimi, S., Bussu, F., Corbo', M., Baroni, S., Galli, J., DUPILUMAB-INDUCED BLOOD EOSINOPHILIA IN PATIENTS WITH CHRONIC RHINOSINUSITIS WITH NASAL POLYPS: TEMPORAL TRENDS AND CORRELATION WITH ADVERSE EVENTS, <<JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE>>, 2025; (S2213-2198): N/A-N/A. [doi:10.1016/j.jaip.2025.10.032] [https://hdl.handle.net/10807/324716]
DUPILUMAB-INDUCED BLOOD EOSINOPHILIA IN PATIENTS WITH CHRONIC RHINOSINUSITIS WITH NASAL POLYPS: TEMPORAL TRENDS AND CORRELATION WITH ADVERSE EVENTS
De Corso, Eugenio;Montuori, Claudio;Settimi, Stefano;Bussu, Francesco;Corbo', Marco;Baroni, Silvia;Galli, Jacopo
2025
Abstract
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) patients treated with dupilumab may experience an increase in blood absolute eosinophil count (AEC). However, onset and temporal pattern of dupilumab-induced blood eosinophilia (DIBE) have not been thoroughly investigated in real life. Objective: To evaluate DIBE prevalence and temporal pattern in CRSwNP patients, to determine associations between DIBE and adverse events (AEs), patients' clinical characteristics and treatment outcomes. Methods: This is a multicentric historical prospective observational study conducted across 14 Italian centres of DUPIREAL network. DIBE onset and temporal pattern, clinical characteristics, CRSwNP outcomes and AEs were analyzed. DIBE was defined as AEC 50% increased from baseline and at least >500 cells/mm3 or AEC >1500 cells/mm3. Results: A total of 564 CRSwNP patients were enrolled. Mean AEC peaked at 3 months and declined by 12 months. Among patients developing DIBE (48.2%), three distinct temporal patterns were identified basing on onset and duration: early-onset temporary (group 1, 30.7% patients), early-onset persistent (group 2, 14.4% patients), and late-onset (group 3, 3.2% patients). Asthma prevalence (p<0.001), use of asthma inhalers (p<0.001) and previous oral corticosteroid (OCS) use (p<0.045) were greater in patients with DIBE (group 1-3) than in patients without DIBE (group 0). DIBE >1500 cells/mm3 was associated with a higher risk of developing mild AEs (p<0.001). DIBE occurrence did not influence dupilumab outcomes in CRSwNP patients. Conclusion: Distinct DIBE patterns have been identified in CRSwNP patients, based on eosinophilia temporal trends. DIBE was mainly observed in comorbid asthma patients and previous use of systemic steroids. The findings confirm that DIBE is a mostly transient and harmless phenomenon associated only with mild AEs.
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
