How Does Dupixent Change Nasal Airflow: A Computational Fluid Dynamics Study

Sunday, September 29, 2024

10:06 AM – 10:12 AM EDT

Location: MBCC, 230

Disclosure(s):

Ahmad O. Odeh, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Zhenxing Wu, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Aspen R. Schneller, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Dupilumab is a monoclonal antibody approved for treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) that may provide more consistent efficacy than other treatment options, yet literature is sparse on its exact effect on airway patency and nasal airflow. The goal of this study is to use computational fluid dynamics (CFD) to investigate a case series.

Methods: A total of 9 subjects were recruited and completed the Sinonasal Outcomes Test (SNOT-22), Nasal Obstruction and Symptom Evaluation (NOSE), and Visual Analog Scale (VAS) of nasal congestion at baseline and 3 or more months after using dupilumab. Clinical and research CT scans were obtained at pre and post treatment, based on which patient specific CFD models were constructed, and Lund Mackey (LM) scores were calculated.

Results: All symptom scores significantly improved from baseline to post-dupilumab (SNOT-22: 58 ± 12.3 to 13 ± 15.7; NOSE: 87.8 ± 8.3 to 16.1 ± 20.6; VAS: 7.7 ± 1.9 to 1.7 ± 1.9, all p < 0.001). Cross-sectional area (CSA) and airflow rate (AFR) in the middle but not inferior meatus increased significantly post-treatment (CSA: 0.28 ± 0.2 to 0.72 ± 0.63 cm2, p < 0.05; AFR: 18.7 ± 20.9 to 70 ± 47.9 ml/s, p < 0.05). These regional airway and airflow variables significantly correlated with symptoms scores (CSA: r = 0.44-0.45, AFR: r = 0.49-0.56, all p < 0.05). Nasal resistance also significantly decreased post-treatment (86.6 ± 33.7 to 57.4 ± 14.1 Pa/ml*s, p < 0.05) and correlated with all symptoms scores (r = 0.52-0.68, all p < 0.05). Lund-Mackey (LM) scores also significantly improved (15.89 ± 6.35 to 8.83 ± 3.54; p < 0.001) and significantly correlated with SNOT and NOSE scores (r = 0.51-0.56, p < 0.05), but still with moderate residual inflammation post-dupilumab.

Conclusions: The impact of dupilumab treatment on nasal airway patency and airflow in CRSwNP is not uniform and more profound in the middle but not inferior meatus. Our study is the first to demonstrate that this regional increase in CSA and AFR and decrease in nasal resistance significantly correlates with patient reported outcomes (PROMs) and drives improvement in patient symptoms.

Presenting Author(s)

Ahmad O. Odeh, BS

Medical Student
Saint Louis University School of Medicine
Columbus, OH, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Zhenxing Wu, PhD

Postdoctoral researcher
Department of Otolaryngology, Head&Neck Surgery, the Ohio State University Wexner Medical Center
Columbus, OH, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Aspen R. Schneller, BS

Student Research Assistant
Department of Otolaryngology, Head&Neck Surgery, the Ohio State University Wexner Medical Center
Radnor, OH, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
JM

James Mihalich

Department of Otolaryngology, Head&Neck Surgery, the Ohio State University Wexner Medical Center, United States

Disclosure information not submitted.
Zachary T. Root, BS

Clinical Research Assistant
The Ohio State University Wexner Medical Center Department of Otolaryngology
Columbus, OH, United States

Disclosure information not submitted.
Christopher D. Brooks, MD

Assistant Professor of Allergy/Immunology
Department of Otolaryngology, Head&Neck Surgery, The Ohio State University Wexner Medical Center
Columbus, OH, United States

Disclosure information not submitted.

Senior Author(s)

Kathleen M. Kelly, MD

Assistant Professor, Rhinology / Endoscopic Skull Base Surgery
The Ohio State University Wexner Medical Center Department of Otolaryngology
Columbus, OH, United States

Disclosure information not submitted.
BO

Bradley Ia Otto, MD

Director, Division of Rhinology
The Ohio State University Wexner Medical Center Department of Otolaryngology
Columbus, OH, United States

Disclosure information not submitted.
Kai Zhao, PhD

Associate Professor
Department of Otolaryngology, The Ohio State University College of Medicine
Columbus, OH, United States

Disclosure information not submitted.