Treatment of Chronic Rhinosinusitis with Nasal Polyps

Introduction to Dupilumab

Dupilumab is a fully human monoclonal antibody that binds to the interleukin-4 receptor α (IL-4Rα) subunit, inhibiting both IL-4 and IL-13 signaling pathways, and blocking key drivers of type 2 inflammation involved in multiple inflammatory conditions, according to the American Academy of Allergy, Asthma, and Immunology 1

Dupilumab is highly effective for treating chronic rhinosinusitis with nasal polyps (CRSwNP), significantly improving nasal polyp burden, quality of life, and symptoms in patients with inadequately controlled disease, with benefits observed regardless of comorbid asthma or NSAID-exacerbated respiratory disease 1
Dupilumab improves multiple outcomes, including:
Dupilumab also improves lung function in patients with comorbid asthma 1

The standard dosing of dupilumab is 300 mg subcutaneously every 2 weeks 1
Dupilumab should be administered subcutaneously into the thigh, abdomen, or upper arm, with rotation of injection sites and consideration of completing all age-appropriate vaccinations prior to initiating treatment 1
Concomitant therapy with intranasal corticosteroids should be continued during treatment with dupilumab, as recommended by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020) 1

Dupilumab is recommended for adult and pediatric patients aged 12 years and older with inadequately controlled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) 3, 1
Patients who may benefit most from dupilumab for CRSwNP include those with high baseline disease severity, patients with comorbid asthma or atopic dermatitis, and those who have not sufficiently benefited from intranasal corticosteroids or surgery 2

Dupilumab is particularly effective in patients with comorbid asthma, improving both upper and lower airway symptoms 1
The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020) strongly supports the use of dupilumab for chronic rhinosinusitis with nasal polyps (CRSwNP) in patients with inadequately controlled disease 1
The American Academy of Allergy, Asthma, and Immunology recommends dupilumab as a first choice biologic for CRSwNP patients, according to expert consensus 3

Regular assessment of treatment response using validated measures, such as SNOT-22, VAS, and smell testing, is recommended 1
Common adverse effects of dupilumab include:
Treatment-related adverse events are generally mild to moderate, although hypersensitivity reactions and eosinophilic conditions can occur, particularly when reducing oral corticosteroids 1
Patients should be monitored for eye symptoms, signs of hypersensitivity reactions, and eosinophilic conditions, especially when reducing oral corticosteroids 4