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| Poster #219 Unique features of nasal airway and airflow improvements post-Dupilumab: a computational investigation of its effectiveness in relieving olfactory losses |
| Nidhi Jha, Ahmad Odeh, Zhenxing Wu, Aspen R. Schneller, James Mihalich, Christopher Brooks, Casey Curtis, Monika Craft, Kara Wada, Bradley A. Otto, Kathleen M. Kelly, Kai Zhao The Ohio State University College of Medicine, Columbus, OH, United States |
Dupilumab is a monoclonal IgG4 antibody for treatment of chronic rhinosinusitis with nasal polyps. It has been shown to produce rapid and sustained improvement in olfactory functions even prior to significant reduction of polyps. We used patient-specific computational fluid dynamics modeling to investigate its precise effect on nasal airway patency and airflow patterns to see how these changes may contribute to olfactory improvement. 12 patients completed the Sinonasal Outcomes (SNOT-22), as well as clinical and research CT scans, pre and 3 months post Dupilumab treatment. During the treatment, all patients received a standard 300 mg dupilumab subcutaneously every 2 weeks. Indeed, SNOT22 symptom scores, including an inquiry about smell and taste symptoms, significantly improved from baseline to post-dupilumab (0-5 scale: 4.58 ± 0.51 to 1.25±1.36, p<0.01). Nasal airway cross-sectional area (CSA) and airflow rate (AFR) in the middle and superior but not inferior meatuses significantly increased post-treatment (CSA: 0.26±0.19 to 0.59±0.59 cm2, p<0.05; AFR: 15.4 ± 20 to 55 ± 50 ml/s, p<0.05). These regional increases significantly correlated with olfactory symptoms score (CSA: r=-0.49, AFR: r=0.49-0.50, all p<0.05). Surprisingly, nasal resistance did not significantly decrease post-treatment (p=0.08). Lund Mackay score significantly improved post-dupilumab (14.4±6.3 to 9.8±4.6; p<0.05) and significantly correlated with SNOT-22 scores (r=0.41, p<0.05), but still with moderate residual polyps. The impact of dupilumab on nasal airway patency and airflow is not uniform but more pronounced in the middle and superior meatus. These unique regional changes may explain previously reported rapid and sustained improvement in sense of smell post- dupilumab. |