Revision endoscopic sinus surgery is rarely needed in dupilumab-treated chronic rhinosinusitis with nasal polyps

This study was set out to investigate the incidence of revision endoscopic sinus surgery (ESS) in patients treated with dupilumab for chronic rhinosinusitis with nasal polyps (CRSwNP). Furthermore, clinical course and outcome of surgery of these patients was described.

A prospective observational cohort study of adult and biological-naive patients with CRSwNP treated with dupilu-mab as per EPOS2020 indication criteria (at least one previous ESS) was undertaken. Patients that had ESS due to an insufficient response to dupilumab were compared to those still on treatment. Baseline demographics and clinical characteristics (such as evidence of type 2 inflammation, SNOT-22 score, and nasal polyp score) were compared between the two groups. Furthermore, clinical measurements at indication of surgery, type of surgery and clinical outcomes are described.

Discontinuation of dupilumab treatment occurred in 41 out of 394 (10.4%) patients, of whom 10 (2.5%) stopped because of an insufficient response. Seven of these patients (1.8% of total) underwent revision ESS. The patients that needed revision sur-gery for uncontrolled CRSwNP were significantly more often male, had lower baseline serum IgE and longer time since the last ESS compared to those still on dupilumab. Despite revision ESS, disease control postoperatively was insufficient in all but two patients.

Revision endoscopic sinus surgery as an escape-treatment for uncontrolled CRSwNP despite dupilumab is rarely needed. The disappointing results of revision ESS for patients with uncontrolled CRSwNP who failed dupilumab calls for new treatments for this limited group.