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Published on: June 20, 2018
Comparison of Dupilumab and Revision Endoscopic Sinus Surgery for Recurrent Chronic Rhinosinusitis with Nasal Polyps:
Bartłomiej Kamiński1, Dominika Ochab2,3, Stanisław Flaga4
1Department of Otolaryngology, Maria Skłodowska-Curie District Hospital, 26-110 Skarżysko-Kamienna, Poland.
Abstract:
Background: Despite growing evidence supporting the efficacy of dupilumab in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), studies directly comparing biologic therapy with revision endoscopic sinus surgery remain limited. This study aimed to compare the effectiveness of dupilumab and revision endoscopic sinus surgery (ESS) in patients with recurrent CRSwNP. Methods: A retrospective cohort study was conducted in 50 patients with CRSwNP who had previously undergone at least two endoscopic sinus surgeries. Twenty-three patients received dupilumab, while twenty-seven underwent revision surgery. Changes in Nasal Polyp Score (NPS), quality of life assessed using the Sino-Nasal Outcome Test-22 (SNOT-22), and olfactory function evaluated with the Sniffin' Sticks test were analyzed. Final clinical outcomes and the proportion of patients achieving very good disease control were also assessed. Results: Both treatment modalities improved disease control. However, dupilumab was associated with significantly greater reductions in NPS (median [IQR]: -6.00 [-6.00 to -5.00] vs. -4.00 [-6.00 to -3.00]; p = 0.012), larger improvements in SNOT-22 scores (-59.39 ± 12.14 vs. -21.37 ± 20.15; p < 0.001), and better recovery of olfactory function (+4.65 ± 2.79 vs. +2.19 ± 2.08; p = 0.001) compared with revision surgery. Analysis of final outcomes also favored dupilumab, with lower NPS scores (median [IQR]: 0.00 [0.00-1.00] vs. 1.00 [0.00-2.50]; p = 0.023), and better olfactory function (7.65 ± 3.11 vs. 4.78 ± 2.34; p < 0.001). Very good symptom control (SNOT-22 < 20) was achieved by 82.6% of patients treated with dupilumab compared with 7.4% of those undergoing revision surgery. Conclusions: Both revision surgery and dupilumab improved disease control in patients with CRSwNP. In this cohort, dupilumab was associated with greater reductions in disease severity, superior quality-of-life outcomes, and better olfactory function than revision endoscopic sinus surgery.