Dupilumab demonstrates sustained effectiveness in treating chronic rhinosinusitis with nasal polyps (CRSwNP) over a three-year period, according to a recent multicenter, retrospective analysis conducted across five tertiary referral centers in Germany. The study, led by Patrick Huber from the Ludwig Maximilian University of Munich, highlights the drug's ability to provide long-term improvements in symptoms, disease-related impairment, nasal polyp burden, and olfactory function in adult patients with CRSwNP.
The research team evaluated real-world data from patients aged 18 and older with CRSwNP who had inadequate disease control and met the criteria for biologic treatment based on the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS2020) guidelines. Prior to dupilumab administration, the team collected extensive medical histories, including details on oral corticosteroid use, previous sinus surgeries, blood eosinophilia, and comorbidities related to type 2 inflammation, such as allergic rhinitis, asthma, urticaria, and eczema.
Dupilumab was administered as the primary biologic treatment, with patients continuing intranasal corticosteroids. The study included subjects who completed a 36-month follow-up by December 2023. Dupilumab was given via a 300 mg subcutaneous injection every two weeks, with tapering as needed for strong responders. Subjective and objective assessments, including respiratory biomarkers, were conducted at treatment initiation and follow-up time points.
Significant Clinical Improvements
The study, which included 150 adult patients, showed significant improvements in clinical measures from baseline to the 36-month mark (n = 138). Visual Analog Scale (VAS) scores decreased from 7.5 ± 2.5 to 1.6 ± 1.3, indicating substantial reductions in disease-related impairment. Nasal Polyp Scores (NPS) also improved, decreasing from 5.3 ± 1.8 to 0.7 ± 1.1. Furthermore, scores on the Sinonasal Outcome Test-22 (SNOT-22) decreased from 59.4 ± 19.4 to 18.0 ± 15.0, reflecting improved rhinosinusitis symptoms.
Olfactory Function and Treatment Response
Participants experienced notable improvements in olfactory function, with scores increasing from 3.2 ± 2.5 to 8.4 ± 2.8. By the 36-month follow-up, approximately 75% of individuals had either normosmia or hyposmia. Based on the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA23) criteria, 76.5% of subjects were given a treatment response labeled as 'excellent' after 36 months.
Safety and Tolerability
Discontinuation occurred in 16 participants, with 12 discontinuing permanently. The team noted 69 adverse events among 48 subjects, most of which were self-limiting.
"Revealing sustained improvements across clinical parameters, this study shows the enduring effectiveness of dupilumab on disease-related impairment, rhinosinusitis symptoms, nasal polyp burden, and olfactory function," the researchers concluded, highlighting the potential of dupilumab as a long-term treatment option for CRSwNP.
