Introduction: Monoclonal antibodies (biologics) are increasingly used in the treatment of severe uncontrolled forms of chronic rhinosinusitis with nasal polyps. In some patients with comorbidities, a combination therapy of biologics needs to be discussed and can be useful as an individual therapy concept.

Material and methods: Case report of a patient from the biologics consultation hour at the University Hospital Hamburg-Eppendorf.

Results: The 33-year old patient was diagnosed with eosinophilic granulomatosis with polyangiitis in 2015. In the course of the disease the patient displayed purpura as well as pulmonary, cardiac and transient neurological symptoms with tissue and peripheral eosinophilia. Therapy was initiated with azathioprine (50 mg/d) and mepolizumab (100 mg/every 4 weeks). In 2021, a pansinus surgery was performed for the treatment of chronic rhinosinusitis with nasal polyps. Due to pulmonary decompensation, the dose of mepolizumab (300 mg/every 4 weeks) was increased in February 2023. In the clinical examination, the patient further presented an NPS of 6 and anosmia. The SNOT-22 was 52. Our interdisciplinary Board of Allergy and Immunology therefore recommended the additional administration of dupilumab every 2 weeks. The combination therapy of mepolizumab and dupilumab showed a significant reduction in SNOT-22 and an increase in olfactory ability. To date there have been no significant side effects.

Discussion: The case report shows the effectiveness and tolerability of the combination of these two biologics for severe forms of chronic rhinosinusitis with nasal polyps. The indication should be provided after interdisciplinary expert discussion and reevaluated regularly. Furthermore, all cases should be collected for future treatment recommendations.

Dr. Hoffmann recieved honoraria for lectures of Sanofi, GSK and Novartis and participated in advisory boards.