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Observational Study
. 2023 Oct;78(10):2684-2697.
doi: 10.1111/all.15796. Epub 2023 Jul 2.

Two-year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months

Rik Johannes Leonardus van der Lans  1 , Josje Janna Otten  1 , Gwijde Flavius Jacobus Petrus Maria Adriaensen  1 , Dinand Rienk Hoven  1 , Linda Berendina Benoist  1 , Wytske Johanna Fokkens  1 , Sietze Reitsma  1
Affiliations
Observational Study

Two-year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months

Rik Johannes Leonardus van der Lans et al. Allergy. 2023 Oct.

Abstract

Background: Dupilumab is an anti-T2-inflammatory biological registered for chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), indicated by integrated CRS-care pathways when optimal medico-surgical treatment yields insufficient CRS control. This study aims to evaluate long-term results with focus on established therapeutic efficacy while tapering dupilumab.

Methods: Real-life, prospective observational cohort study in single tertiary referral center with add-on dupilumab as primary biological treatment in adult (≥18 years) biological-naïve CRSwNP patients per the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS)2020-indication with a 2-year follow-up. Tapering (increasing interdose interval) applied every 24 weeks, conditional to sufficient treatment response and CRS control.

Results: Mean scores (s.d.) of all co-primary outcomes improved significantly from baseline ( 228) to the 48 ( 214) and 96-weeks ( 99) timepoints: Nasal Polyp Score (0-8) improved from 5,3 (1,9) to 1,4 (1,8) and 1,3 (1,7); SinoNasal Outcome Test (SNOT)-22 (0-110) improved from 53,6 (19,6) to 20,2 (15,4) and 21,2 (15,6); Sniffin'Sticks-12 identification test (0-12; 0-6 anosmia, 7-10 hyposmia, 11-12 normosmia) improved from 3,7 (2,4) to 7,7 (2,9) and 7,3 (3,04); Asthma Control Test (5-25; >19 indicating well-controlled asthma) improved from 18,5 (4,8) to 21,8 (3,8) and 21,4 (3,9). Tapering was feasible in 79,5% of the patients at the 24-weeks timepoint, and in 93,7% and 95,8% at the 48- and 96-weeks timepoints, respectively. One-way repeated-measures ANOVA demonstrated no significant alterations of individual co-primary outcome mean-scores from 24 weeks onward.

Conclusion: This first long-term real-life prospective observational cohort study shows high therapeutic efficacy of dupilumab for severe CRswNP in the first 2 years. Therapeutic efficacy is principally established within 24 weeks and endures while tapering dupilumab conditional to treatment response and CRS control.

Keywords: CRSwNP; biological therapy; dupilumab; long term; nasal polyps; observational study; sinusitis; treatment outcome.

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References

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