Obstructive sleep apnoe improves on Dupilumab in patients treated for polyposis and severe asthma

Background: Obstructive sleep apnoe (OSA) is a frequent comorbidity in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) or severe asthma. Aim: To determine whether OSA improves on dupilumab in patients with type 2 inflammation. Method: The clinical outcome of 5 male patients with severe asthma with comorbid CRSwNP and OSA (3/5 under cPAP ventilation) was assessed on dupilumab treatment q2w (300 mg) for at least 6 months at time of last visit (6 mo: 2/5, 8 mo: 1/5, 12 mo: 2/5) to identify changes in their severe asthma, CRS, and OSA parameters. Baseline characteristics at 1st injection of dupilumab: age mean 58 yrs., BMI 55.7 kg/m², CRS with polyposis in 5/5, FeNO mean 39.5 ppb, eosinophils mean 896/ul, IgE mean 200 kU/l, atopy in 4/5, ASS intolerance in 2/5, anosmia in 4/5. Results: OSA symptoms were reduced in 5/5 with less night symptoms and "remarkably" reduced fatigue during the day in 4/5. 4/5 patients had normal smelling and improvement in their CRSwNP symptoms. Asthma also improved: 3/5 patients were on OCS therapy (Median 5 mg) at therapy initiation and could discontinue OCS. FEV1% pred. increased from mean 50.8% to mean 68.0%. Conclusions: Here for the first time we can show in a case series that OSA can improve on dupilumab therapy. Treated OSA patients were characterized by high eosinophilia, elevated FeNO, moderatly high IgE and an atopic background in most cases, indicative of underlying type 2 inflammation.