Role of FeNO and nasal NO in CRSwNP-patients on monoclonal antibody therapy

In pneumology, fractional exhaled nitric oxide (FeNO) is considered an important parameter for phenotyping in patients with severe asthma with regard to biological therapy. Such a phenotyping is not yet available in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) and so far little data is available on changes in FeNO and nasal nitric oxide (nNO) under biological therapy. In this study, the baseline values of FeNO and nNO were determined in 42 CRSwNP patients before starting treatment with dupilumab or omalizumab and the course was assessed over 6 months. It was shown that the FeNO was increased in 75% of the patients (>25ppb), even in those with no history of asthma or well-controlled asthmatics (mean value at the start of therapy 53.6ppb). Over time, the value decreased to 30.8ppb (3 months) and 30.1ppb (6 months) and the reduction in the polyp score correlated with the reduction in FeNO after 6 months (correlation coefficient according to SpearmanRho: -0.415, p=0.007). At the start of therapy, there was a correlation between the nNO values determined separately for each side of the nose and the polyp score (correlation coefficient according to SpearmanRho right: -0.357, p=0.026 and left: -0.449, p=0.017). The mean value of the nNO was initially 151ppb (normal value >300ppb). After 3 months it increased to 280ppb and after 6 months to 343ppb. Measurement of FeNO and nNO provided meaningful additional information in patients receiving biological therapy for CRSwNP and could qualify as a biomarker in the future. Publication History Article published online: 12 May 2023 Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany