USE OF DUPILUMAB IN CHRONIC RHINOSINUSITIS WITH DIFFICULT TO MANAGE NASAL POLYPOSIS: CASE REPORT (Atena Editora)

Abstract

Introduction: The present study aims to report a clinical-surgical case of a patient with aspirin-exacerbated respiratory disease (ASR), with chronic rhinosinusitis with nasal polyposis (CRSwNP) that is difficult to control and its evolution with the use of dupilumab in the city of Santa Maria, Rio Grande do Sul. It also intends to review the pathophysiological mechanisms of the disease and the current and future perspectives in relation to the treatment of the pathology. Clinical case: Male patient, 53 years old, sought specialized care in Otorhinolaryngology in 2017 due to chronic nasal obstruction. He had already undergone two sinonasal endoscopic surgeries without improvement in his clinical condition. After the diagnosis of CRSwNP and DREA was established, several therapeutic alternatives were tried, again without effective improvement and the patient was recommended to start immunobiological therapy with dupilumab. Discussion: Treatment with dupilumab resulted in significant clinical improvement, reduction in nasal symptoms, improvement in the SNOT-22 score and Lund-Mackay score in the patient subject of this report. Despite a temporary interruption in the supply of the medication, which led to the patient's clinical worsening, the resumption of treatment resulted in a further improvement in symptoms. Final considerations: Despite the high costs, the use of dupilumab proved to be beneficial and effective in significantly improving endoscopic, radiological and clinical parameters of patients with severe CRSwNP, reducing the need for surgery and the use of systemic corticosteroids as rescue treatment. The drug demonstrated to be an effective therapeutic alternative for patients with severe CRSwNP.