[Dupilumab therapy of patients with chronic rhinosinusitis with nasal polyps: long-term observational study]

Introduction: Chronic rhinosinusitis with nasal polyps is considered as a predominantly T2 immunopathological disease, which despite symptomatic medical and surgical treatments, often leads to persistent deterioration in the quality of life. The use of biological therapy has shown significant progress in treating refractory endotypes. With the first choice option dupilumab, there is a five-year experience in Hungary. Method: In a two-center retrospective study, we included 137 patients treated with dupilumab between October 2020 and January 2025; 107 of them have at least six months follow-up data. According to professional guidelines, we assessed the degree of nasal obstruction using a visual analogue scale, polyp extent by endoscopy, olfactory dysfunction with symptom scores, and the quality of life using specific questionnaires. Results: The average treatment duration was 554.6 ± 355.3 days, with 6 patients treated for more than four years, 16 patients for more than three years, 54 patients for more than two years, and 104 patients whose therapy started more than one year ago. T2 comorbidities were as follows: asthma in 105 patients (76.64%), nonsteroidal anti-inflammatory drug intolerance in 63 patients (45.99%), and allergic rhinitis in 69 patients (50.36%). The patient parameters significantly improved in comparison to baseline values at all time points (p<0.001). Olfactory dysfunction, significantly affecting the quality of life, improved in 71.96% of patients. Side effects were observed in 25 cases (23.36%), leading to therapy discontinuation in 5 patients (3.65%). The most common side effects were joint pain, elevated blood eosinophil count (8 cases each), skin and mucous membrane reactions (n = 7). In 27% of patients, the dupilumab dose could be reduced without compromising efficacy. Conclusion: In our long-term follow-up study on a large patient cohort, we demonstrated that dupilumab is significantly more effective than conventional treatments and safe when treatment principles are followed. Orv Hetil. 2025; 166(29): 1123–1131.