First experience of using tezepelumab for the treatment of chronic rhinosinusitis with nasal polyps in the Moscow region

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nasal mucosa and paranasal sinuses associated with severe nasal congestion, olfactory impairment, decreased quality of life, the need for repeated surgical interventions, and the use of systemic glucocorticosteroids. Real-world data on the use of tezepelumab in patients with severe relapsing CRSwNP remain limited. OBJECTIVE: To describe the initial experience of tezepelumab application in real-world setting in patients with recurrent rhinosinusitis with nasal polyps and to evaluate early improvement of symptoms, quality of life, and tolerability of therapy based on available clinical data. MATERIAL AND METHODS: We describe clinical observations of 8 patients with recurrent CRSwNP who received tezepelumab 210 mg subcutaneously every 4 weeks for 2 months. Patients were treated in a multidisciplinary day hospital. The total severity of symptoms was assessed using the visual analogue scale (VAS), quality of life - using the SNOT-22 questionnaire, the initial endoscopic picture - using the Lund-Kennedy score. In addition, peripheral blood eosinophils, treatment history, comorbidity and tolerability of therapy were evaluated. The primary assessment was performed at the baseline visit and approximately 2 months after the start of treatment. The analysis was descriptive. RESULTS: The series included 8 patients, 6 of whom were women; the mean age was 54.2±9.0 years. All patients had recurrent CRSwNP and a history of surgical interventions. Bronchial asthma was described in 5 of 8 patients, and intolerance to nonsteroidal anti-inflammatory drugs or Samster's triad - in 4 of 8. Initially, the average score for VAS was 30.2±1.7, for SNOT-22 - 63.8±3.9. After 2 months, the mean VAS score decreased to 11.0±1.2, the average absolute change amounted to 19.2±1.5 points. The mean SNOT-22 score decreased to 30.1±5.8, with an average absolute change of -33.6±5.9 points. Improvement in VAS and SNOT-22 scores was observed in all 8 patients. The course of treatment was continued for all patients due to clinical improvement. CONCLUSION: In this small case series, tezepelumab was associated with an early reduction in symptom burden and improved quality of life in patients with severe recurrent rhinosinusitis with nasal polyps. The obtained observation results are preliminary. Confirmation in larger, systematically assembled cohorts with longer follow-up and standardized assessment of endoscopic, radiographic symptoms and safety indicators is needed.