Chronic Rhinosinusitis With Nasal Polyps
Conditions
Keywords
CRSwNP, dupilumab
Brief summary
The central hypothesis of this study is that the addition of dupilumab treatment onto standard-of-care intranasal corticosteroids will improve patient-reported measures of disease activity and sense of smell in a cohort of mostly ethnical and racial minority patients with CRSwNP.
Detailed description
First, it will confirm the effectiveness of dupilumab in the treatment of CRSwNP in ethnic and racial minority patients who have traditionally been underrepresented in existing clinical trials of biologics in CRSwNP Second, this research will establish a biomarker of therapeutic response to dupilumab identifying the biological effect of dupilumab in CRSwNP patients and its association with symptom improvement. Finally, the investigators will measure the effect of dupilumab on asthma symptoms and lung function in patients with CRSwNP and comorbid asthma. There will be a screening visit, followed by a baseline visit where the medication will be given. Follow-up visits will be scheduled at 2 weeks and then 16 weeks from baseline. Long-term visits will take place in 36 and 52 weeks.
Interventions
BIOLOGICALDupilumab
Standard of care treatment with dupilumab
Sponsors
Montefiore Medical Center
Regeneron Pharmaceuticals
Mayo Clinic
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with physician-diagnosed CRSwNP, with or without comorbid asthma that meet indication criteria for FDA-approved use of Dupilumab. * Patients aged 18 years and older. * Patient willing to provide consent to be a participant in the study. * Patients with insurance that allows Dupilumab coverage or Dupilumab coverage obtained through "Dupixent MyWay Program"
Exclusion criteria
* Age under 18 * Suspected or diagnosed allergic fungal rhinosinusitis. * Suspected or diagnosed cystic fibrosis. * Dupilumab coverage denied through insurance or "Dupixent MyWay Program" * Patients who required a steroid taper in the preceding 30 days. However, patients on chronic steroids less or equal to 20 mg of prednisone daily, are eligible. * Patients who were on a different biologic medication in the preceding 3 months. * Patients with a diagnosis of Eosinophilic granulomatosis with polyangiitis (EGPA)/Churg-Strauss Syndrome * Pregnant patients * Patients with inverted papilloma growth
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline in Sino-Nasal outcome test (SNOT-22) score | Baseline, 2 weeks, 16 weeks, 36 weeks, and 52 weeks post-administration | Change in sinonasal values from baseline will be assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22). The SNOT-22 is a 22-item patient questionnaire used to measure symptom severity and related quality of life in people with chronic rhinosinusitis or nasal problems. Each of the 22 items is measured using a 6-point Likert scale ranging from 0 ("No problem") to 5 ("Worst possible problem"), yielding an overall scoring range of 0-110, such that higher scores are indicative of worsening symptom burden. This outcome measure will only be assessed longitudinally in the participants receiving Dupilumab. |
| Change from baseline in Smell Function | Baseline, 2 weeks, 16 weeks, 36 weeks, and 52 weeks post-administration | Change in smell function from baseline will be assessed using the University of Pennsylvania Smell Identification Test (UPSIT). The UPSIT is a standardized 40-item "scratch-and-sniff" test of olfactory function. Each participant is provided with four small booklets containing a total of 40 microencapsulated scent strips and is instructed to scratch the strip, sniff the odor, and pick the correct answer from a multiple-choice list of four options per item. Each correct identification of a scratch-and-sniff odor gives one point, yielding an overall possible scoring range of 1-40. Lower scores reflect a reduced ability to identify odors. This outcome measure will only be assessed longitudinally in the participants receiving Dupilumab. |
| Change from baseline in Nasal Peak Flow (NPF) | Baseline, 2 weeks, 16 weeks, 36 weeks, and 52 weeks post-administration | Change in NPF values from baseline will be evaluated in the clinic. Peak nasal inspiratory flow (PNIF) normal values typically range from 80-180 Liters per minute (L/min) in healthy adults, varying based on age, sex, and physical stature. Higher values are indicative of greater nasal airway patency. Change from baseline values will be expressed in units of L/min. This outcome measure will only be assessed longitudinally in the participants receiving Dupilumab. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline in urinary Leukotriene E4 (uLTE₄) levels | Baseline, 2 weeks, 16 weeks, 36 weeks, and 52 weeks post-administration | Change in uLTE₄ levels from baseline will be assessed in the clinic. Urine samples will be collected during each specified timepoint, and samples will be processed and analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS) or the appropriate immunoassay. Normal reference ranges for uLTE4 is ≤ 104 picograms per milligram (pg/mg) creatinine. Elevated uLTE₄ levels are indicative of heightened systemic or airway cysteinyl leukotriene activity and serve as a reliable, non-invasive biomarker for several inflammatory, respiratory, and hypersensitivity disorders. Change from baseline values will be expressed in units of pg/mg. This outcome measure will only be assessed longitudinally in the participants receiving Dupilumab. |
| Change from Baseline in Absolute Peripheral Blood Eosinophil Count | Baseline, 2 weeks, 16 weeks, 36 weeks, and 52 weeks post-administration | Changes in Absolute Eosinophil Count from peripheral blood from baseline will be assessed in the clinic. Blood samples will be drawn during each prespecified timepoint and analyzed using automated hematology analyzers or manual microscopy as part of a Complete Blood Count (CBC) with differential. Absolute Eosinophil Counts (AEC) vary by laboratory but are generally in the range of 0-500 cells per microliter (cells/µL) of blood. Elevated AEC in peripheral blood is indicative of increased in eosinophilic conditions as evident from rashes, worsening pulmonary symptoms and/or neuropathy. Change from baseline values will be expressed in cells/uL. This outcome measure will only be assessed longitudinally in the participants receiving Dupilumab. |
| Change from Baseline in Serum Total Immunoglobulin E (IgE) Levels | Baseline, 2 weeks, 16 weeks, 36 weeks, and 52 weeks post-administration | Changes in total serum IgE levels from baseline will be assessed in the clinic. Blood samples will be drawn during each prespecified timepoint and analyzed using automated immunoassay techniques to measure the concentration of circulating IgE. Standard reference ranges vary by laboratory assay, age, and individual baseline factors but are generally in the range of 0-100 International Units per milliliter (IU/mL) of blood. Elevated IGe concentrations can be indicative of a number of clinical indications including atopic and allergic diseases. Change from baseline values will be expressed in IU/mL. This outcome measure will only be assessed longitudinally in the participants receiving Dupilumab. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORGolda Hudes, MD
Montefiore Medical Center
Outcome results
None listed