Successfully treating diseases and infections of the sinuses is a challenging part of my professional life. Multiple medications, home remedies (like nasal washing) and surgical procedures are available and most provide relief. However, there is one type of chronic sinusitis that is difficult to obtain a long-standing cure. This is the type in which patients develop severe swollen tissue within the nasal passages and sinuses called polyps. Only 25-30% of patients with repeated or chronic sinus infections develop polyps. However, even after extensive surgical removal and a regiment of medical therapy the recurrence rate of polyps is approximately 40%. While polyps are not cancerous, their presence inside the nose and sinuses causes obstruction of airflow, severe drainage, facial pressure and often a severe loss of sense of smell.
Recently, there has been a breakthrough development in the treatment of this condition of the sinusitis with polyp formation. It involves administration of a “biologic” treatment as an injection therapy. The medication which is known as Dupixent (dipilumab) has been FDA approved for the treatment of asthma for approximately 5 years. Within the last year it has gained approval for the treatment of nasal polyps.
The class of biologic therapies have been available for over 20 years. Some are known for treatment of conditions such as rheumatoid arthritis or psoriasis with familiar names such as Humira or Enbrel. They act by blocking part of the immune system that is usually involved with autoimmune diseases. A severe side effect of these medications often is suppression of the immune system making patients susceptible to infections such as tuberculosis or fungal infections.
I am much more excited about Dupixent because it has no blockage of the healthy part of the immune system. Intensive research has shown that nasal polyps are the result of the overproduction of a specific type of inflammatory chemical known as Interleukin-4. When Interleukin-4 is produced along with another type, Interleukin-13 the resultant reaction leads to severe swelling of the area involved. In the lungs the result is asthma, in the skin the result is eczema and in the nose the result is polyps. The new medication is actually an antibody to the Interleukin-4 protein that surrounds it and inactivates it before it can cause the disease process.
Because Dupixent does not significantly impair the immune system there is no need to test for conditions such as tuberculosis or fungal infections.
The medication is available as an injection that is usually administered by the patient at home every 2 weeks. Don’t worry, the needle is very tiny and there is almost no pain.
I currently have patients on this medication who have noticed great relief of their polyps. Many of them are very happy to recover their sense of smell within 2-3 injections. It is an exciting advancement and one more tool available for me to help patients with this serious problem.
