Evaluation of Patient Satisfaction During Treatment With Dupilumab in Severe and Recurrent Nasosinusal Polyposis Despite Appropriate Medical and Surgical Treatment.

Study Overview
=================
Brief Summary
-----------------
Chronic rhinosinusitis with nasal polyps (CRSwNP) or nasal polyposis is a frequent disease leading to a decreased quality of life. The validated course of treatment is firstly a medical one with saline irrigations and topical corticosteroids, followed by surgery (ethmoidectomy) if the medical treatment fails. In many cases, CRSwNP becomes a recurrent disease despite maximal treatment as previously indicated and it becomes refractory, with a chronically reduced quality of life. New treatments known as Biologics or Biotherapies in France such as Dupilumab are now available in situations of severe recurrent CRSwNP despite the appropriate treatment. The goal of this study is to assess the clinical effectiveness of Dupilumab and patient satisfaction, in a cohort of french patients, focusing on the change in quality of life that is expected from said treatment, over a period of one year. Patients will undergo 6 months of treatment with Dupilumab, the treatment will then be stopped for the next 6 months. The primary judgment criteria will be the SNOT 22 score, measured before treatment, after 6 months of treatment, and 6 months after stopping treatment, over a telephonic conversation.

Detailed Description
-----------------
CRSwNP has existed for over 5000 years, it is a frequent disease, affecting 1 to 4 % of the general population, especially older men and is defined by inflammatory modification of the sinuses and nasal cavities with benign growths of the mucosa known as polyps. It leads to numerous symptoms (nasal blockage, anosmia, nasal dripping, fatigue, pain), which have important consequences in terms of quality of life, social interactions, and by the heavy costs that are brought by medical and surgical treatment. It is a multifactorial disease for which physiopathology is not well established. No definitive treatment exists. The appropriate course of treatment aims to control the disease, but not cure it, via topical corticosteroids application which can be facilitated by endoscopic surgery (polypectomy, ethmoidectomy). Recurrence is frequent after surgery (40 %, 18 months after surgery), which leads to more surgeries that get more complicated and riskier each time. CRSwNP is also an expensive disease (several thousands of euros per year for one patient), especially in cases of recurrence after surgical treatment. The indirect costs are also high with work absenteeism and decreased productivity making CRSwNP one of the 10 most costly diseases for US employers. Dupilumab, a biologic treatment targeting the receptors of IL4 and IL13 which are major actors of the inflammatory reaction at hand in CRSwNP, has recently appeared on the market for treatment of severe recurrent CRSwNP despite the appropriate medical and surgical treatment, and has proved its efficacy in randomized clinical trials. It is a very expensive treatment (1400 euros a month for one patient in France), which is why its clinical effectiveness in a real-life setting must be assessed. Hypothesis : Dupilumab improves symptoms and quality of life in severe recurrent CRSwNP despite the appropriate medical and surgical treatment. Objectives : To assess the effect of Dupilumab and patient satisfaction during treatment and after its discontinuation, on symptoms and quality of life in patients suffering from severe and recurrent CRSwNP despite having benefited from the appropriate medical and surgical treatment, in a French real-life cohort.

Official Title
-----------------
Evaluation of Patient Satisfaction During Treatment With Dupilumab in Severe and Recurrent Nasosinusal Polyposis Despite Appropriate Medical and Surgical Treatment.

Conditions
-----------------
Chronic Rhinosinusitis With Nasal Polyps

Intervention / Treatment
-----------------
* Other: Questionnaires


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Women and men over 18 years old Suffering from severe and recurrent Chronic Rhinosinusitis with Nasal Polyps despite having benefited from the appropriate medical and surgical treatment. CRSwNP diagnosis established on the basis of clinical presentation and patient interrogation by their referent ENT surgeon. Patient treated with Dupilumab in the indication depicted in bullet point 2. Patient having voiced their non-opposition to this research, having received clear and appropriate information. Patient affiliated to the French Social Security. Exclusion Criteria: Patient having undergone endoscopic nasal surgery during their Dupilumab treatment. Patient presenting exclusion criteria for Dupilumab treatment. Patient suffering from immune deficit. Patient suffering from vascularitis with nasal expression. Patient whose autonomy has been reduced by a legal authority. Patient unable to express their agreement to participate in this study.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients suffering from severe recurrent CRSwNP and treated with Dupilumab<br>Patients suffering from severe recurrent CRSwNP despite having benefited from the appropriate medical and surgical treatment and treated with Dupilumab for 6 months | Other: Questionnaires<br>* Submission of several questionnaires (Quality of Life and clinical scores) at three time points: before initiation of Dupilumab, after 6 months of Dupilumab treatment, and 6 months after stopping Dupilumab treatment<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of the global effect of Dupilumab 1 day before Dupilumab by the mean of the SNOT 22 score | The SNOT22 score is a validated questionnaire for the assessment of symptoms of Chronic rhinosinusitis, ranging from 0 to 110. The more severe are the disease and its associated symptoms, the higher is the score | 1 day before Dupilumab | 
| Assessment of the global effect of Dupilumab 6 months of Dupilumab treatment by the mean of the SNOT 22 score | The SNOT22 score is a validated questionnaire for the assessment of symptoms of Chronic rhinosinusitis, ranging from 0 to 110. The more severe are the disease and its associated symptoms, the higher is the score | 6 months of Dupilumab treatment | 
| Assessment of the global effect of Dupilumab 6 months after stopping the treatment by the mean of the SNOT 22 score | The SNOT22 score is a validated questionnaire for the assessment of symptoms of Chronic rhinosinusitis, ranging from 0 to 110. The more severe are the disease and its associated symptoms, the higher is the score | 6 months after stopping Dupilumab treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of the effect of Dupilumab on nasal obstruction by the mean of the Visual Analogic Scale for nasal obstruction | Staging nasal obstruction level from 0 to 10. The more severe are the symptoms, the higher is the score | 1 day before Dupilumab, at 6 months of Dupilumab treatment, and 6 months after stopping Dupilumab treatment | 
| Assessment of the effect of Dupilumab on the olfaction by the mean of the Visual Analogic Scale for Olfaction | Staging olfaction levels from 0 to 10. The more severe are the symptoms, the higher is the score | 1 day before Dupilumab, at 6 months of Dupilumab treatment, and 6 months after stopping Dupilumab treatment | 
| Assessment of the effect of Dupilumab on the severity of the nasal polyposis by the mean of the Nasal Polyp Score | Endoscopic based score assessing the severity of nasal polyposis, 0 to 8. The more severe are the symptoms, the higher is the score | 1 day before Dupilumab, at 6 months of Dupilumab treatment, and 6 months after stopping Dupilumab treatment | 
| Assessment of the effect of Dupilumab on the severity of the nasal polyposis on an iconographic level by the mean of the Lund McKay score | CT-scan based score assessing the severity of nasal polyposis on an iconographic level, 0 to 24. The more severe are the symptoms, the higher is the score | 1 day before the treatment initiation | 
| Assessment of the effect of Dupilumab on the quality of life by the mean of the EQ 5D 5L score | Quality of life questionnaire associated with a Visual Analogic Scale ranging from 0 to 100. The more severe are the symptoms, the higher is the score | 1 day before Dupilumab, at 6 months of Dupilumab treatment, and 6 months after stopping Dupilumab treatment | 
| Assessment of the effect of Dupilumab on the severity of the asthma by the mean of the ACT score | Asthma control assessment score ranging from 5 to 25. The more severe are the symptoms, the higher is the score | 1 day before Dupilumab, at 6 months of Dupilumab treatment, and 6 months after stopping Dupilumab treatment | 
| Assessment of the time to first improvement in sense of smell and nasal obstruction with Dupilumab | Time between the beginning of treatment with Dupilumab and the first time a reduction in nasal obstruction and hyposmia was observed by the patient | 1 day | 
| Time between stopping Dupilumab and possible deterioration of the sense of smell and nasal obstruction | Time between the stopping of Dupilumab treatment and the first worsening of nasal obstruction and olfaction that was noted by the patient | 1 day | 
| Evolution of a potential middle ear chronic inflammation during treatment | rate of otitis appearance among the patients during their treatment with Dupilumab | 1 day | 
| Necessity to use oral corticosteroids during or after Dupilumab treatment | Rate of patients in need of corticosteroids during or after their treatment with Dupilumab | 1 day | 
| Evolution to nasosinus superinfections during and after Dupilumab treatment | Rate of nasosinus superinfections appearance observed during or after the treatment with Dupilumab | 1 day | 
| Collect of adverse effects during Dupilumab treatment | collect of adverse effects during Dupilumab treatment | 1 day | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
CRSwNP, decreased quality of life, Nasal polyps, Rhinosinusitis, recurrent CRSwNP, severe CRSwNP