Dupilumab Extended Interval Dosing in Chronic Rhinosinusitis With Nasal Polyps: A Systematic Review and Meta-analysis

Area of Science:

• Immunology
• Otolaryngology
• Pharmacology

Background:

• Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory upper airway disease.
• Dupilumab, an interleukin-4 receptor alpha antagonist, is effective for CRSwNP.
• Optimizing dupilumab dosing intervals may improve patient management and reduce treatment burden.

Purpose of the Study:

• To assess if extending dupilumab dosing intervals beyond every two weeks (Q2W) maintains disease control in CRSwNP patients.
• To evaluate the impact of extended dupilumab dosing on clinical, radiologic, and biomarker outcomes.
• To explore the feasibility of further dose spacing (e.g., Q6W-Q12W) in select CRSwNP individuals.

Main Methods:

• Systematic literature search of PubMed, Scopus, Cochrane Library, and Web of Science up to September 2025.
• Inclusion of studies where adults with CRSwNP switched from dupilumab 300 mg Q2W to extended intervals (≥Q4W).
• Random-effects meta-analyses synthesized sinonasal, radiologic, and biomarker outcomes; risk of bias assessed using RoB2 and NIH tools.

Main Results:

• Nineteen studies involving 1075 patients were analyzed; nine contributed to quantitative synthesis.
• Extended Q4W dupilumab dosing maintained disease control with non-significant changes in SNOT-22, nasal congestion, olfaction, polyp score, and Lund-Mackay scores.
• A significant decrease in eosinophils was observed (-0.13 × 10⁹/L; P = .047); subgroup analyses showed no significant difference in clinical outcomes between 6- and 12-month induction periods.

Conclusions:

• Extending dupilumab dosing to Q4W is effective in maintaining clinical stability for CRSwNP patients after 6-12 months of standard therapy.
• Further extension to Q6W-Q12W may be feasible in specific patient populations.
• Controlled trials are needed to establish optimal tapering strategies and identify predictors for successful dose spacing.