Unique Features of Nasal Airway and Airflow Improvement Post-Dupilumab: A Computational Cohort Study.

Abstract

Dupilumab is a monoclonal antibody approved for treatment of chronic rhinosinusitis (CRS) with nasal polyps, yet literature is sparse regarding its precise effect on nasal airway patency and airflow patterns. This study applied Computational Fluid Dynamics (CFD) modeling to examine the relationship between the changes in nasal structures and aerodynamics and the changes in symptoms after dupilumab treatment. Twelve patients enrolled, completed the Sinonasal Outcomes Score (SNOT-22), as well as CT scans pre and 3 or more months post-dupilumab treatment. Patient-specific CFD models were constructed, and Lund-Mackay (LM) scores were calculated. Nasal airway cross-sectional area (CSA) and airflow rate (AFR) in the middle and superior but not inferior meatuses significantly increased posttreatment (all p < 0.05). These increases correlated with SNOT-22 scores (CSA: r = 0.49, AFR: r = 0.41, p < 0.05), as well as with one question in SNOT-22, decreased sense of smell/taste (CSA: r = 0.32-0.54, AFR: r = 0.29-0.53, p < 0.05), which may explain previously reported rapid improvement in olfaction post-dupilumab. Surprisingly, nasal resistance did not significantly decrease posttreatment (p = 0.12) nor significantly correlate with symptom scores. LM scores significantly improved post-dupilumab (14.4 ± 6.3 to 9.8 ± 4.6; p < 0.05), with moderate residual inflammation. LM significantly correlated with SNOT-22 scores (r = 0.46, p < 0.05), but not with smell/taste complaints. The impact of dupilumab on nasal airway patency and airflow is not uniform. It is more pronounced in the middle and superior, but not inferior meatus. These unique regional changes significantly correlate with and potentially drive the improvement in patient symptoms.