Dupilumab Increases Aspirin Tolerance in NSAID-exacerbated Respiratory Disease.

Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD), an intriguing and incompletely understood condition, is characterised by a triad of asthma, chronic rhinosinusitis with nasal polyps (CRSwNP) and hypersensitivity to aspirin (acetylsalicylic acid; ASA) and other cyclooxygenase-1 inhibiting NSAIDs [1, 2]. Dysregulation of arachidonic acid metabolism leads to chronic overproduction of the cysteinyl leukotrienes and the inflammatory prostaglandin (PG) D2 along with underproduction of anti-inflammatory PGE2; these are further increased acutely on exposure to NSAIDs [1, 2]. Intense T2 eosinophilic inflammation, involving both CRSwNP and asthma, precede the onset of clinical NSAID sensitivity and persist in the absence of NSAID exposure [1]. Schneider et al. add to the growing evidence that dupilumab is very effective in N-ERD inducing increased tolerance to ASA in 57% of patients (complete in 23%), accompanied by improvements in both upper and lower airway clinical features of disease https://bit.ly/3jqs1DC