Prompt Resolution of Chronic Rhinosinusitis with Nasal Polyposis and Chronic Bronchitis After First Dose of Benralizumab

Abstract

Several mAB therapies are approved for treatment of moderate to severe eosinophilic asthma. Clinical trials investigating their efficacy in chronic rhinosinusitis and nasal polyps are encouraging and continued trials are underway. We present a patient treated with benralizumab for refractory nasal polyps and non-allergic, non-asthmatic chronic respiratory symptoms. His symptoms began after noxious exposure to mold, and were associated with eosinophilic polyp tissue and elevated peripheral eosinophil count. He is a never-smoker, fit and healthy ex-military officer with no history of allergic rhinitis or asthma. A PubMed review of all articles reporting data on the use of biologic therapies for nasal polyps and chronic rhinosinusitis with or without nasal polyposis was conducted. A 53-year-old man had been aggressively treated with 8 courses of antibiotics, oral and topical steroids, sinus surgery, and ICS/LABA for sudden onset and refractory chronic rhinosinusitis with eventual development of recurrent nasal polyps and fixed airway obstruction over a period of 2.5 years. Following the 1st dose of benralizumab his symptoms, nasal polyps, and airway obstruction improved dramatically. Upper airway rhinitis and PND as well as lower airway wheezing resolved within 17 days. After 3 months of treatment his spirometry was unobstructed with normal FEV1 (+24% from baseline), and minimal polyp tissue was visible on endoscopic exam. After 12 months benralizumab therapy was stopped. Physicians should consider a trial of anti-eosinophil mABs in patients with nasal polyps especially if there is evidence of eosinophilic inflammation of the upper or lower airway.