Dupilumab, Functional Endoscopic Sinus Surgery Equally Effective in Reducing Chronic Rhinosinusitis with Nasal Polyps Symptoms

by Linda Kossoff  •

How does dupilumab compare with functional endoscopic sinus surgery (FESS) as a treatment for patients with chronic rhinosinusitis with nasal polyps (CRSwNP)?

BOTTOM LINE

Both dupilumab and FESS are effective at reducing symptoms in patients with CRSwNP according to Sino-Nasal Outcome Test (SNOT-22) scores.

BACKGROUND: FESS with topical corticosteroids is a primary treatment modality in patients with CRSwNP and lack of response to appropriate medical therapy. Dupilumab is a recently developed, IgG4 human antibody targeting the type 2 inflammatory pathway associated with CRSwNP. There is currently limited data on the utility of dupilumab.

STUDY DESIGN: Retrospective matched cohort study.

SETTING: Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.

SYNOPSIS: Researchers identified 108 adult patients who were treated for CRSwNP at a single institution from 2015 to 2021. Of these patients, 54 were treated with 300 mg dupilumab administered every other week (55.56% male, mean age 52.39 years) and 54 were treated with bilateral total FESS (50% male, mean age 53.31 years). Both cohorts were treated with topical corticosteroids. Patients were matched based on baseline nasal polyp score (NPS), baseline overall SNOT-22 score, age, sex, and ethnicity. The primary end points were change in NPS and overall SNOT-22 score. Comparison of mean values of independent and categorical variables for the two treatment groups was performed. Findings showed that both treatments were effective. Patients who underwent FESS had greater improvement in NPS than patients treated with dupilumab, but the latter group had greater improvement in SNOT-22 olfaction scores, reporting better smell perception than the surgical cohort. There was no significant difference between the groups in changes of overall SNOT-22 score, however. Study limitations included its retrospective nature, which limited available data.

CITATION: Dharmarajan H, Falade O, Lee SE, et al. Outcomes of dupilumab treatment versus endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol. 2022;12:986–995.