Does Prior Sinus Surgery Influence Dupilumab Treatment Response in CRSwNP?

Area of Science:

• Otolaryngology
• Immunology
• Pharmacology

Background:

• Chronic rhinosinusitis with nasal polyps (CRSwNP) is a debilitating condition.
• Endoscopic sinus surgery (ESS) is a common treatment, but recurrence is frequent.
• Biologic therapies like Dupilumab offer new treatment avenues for CRSwNP.

Purpose of the Study:

• To evaluate if prior endoscopic sinus surgery (ESS) impacts long-term treatment response to Dupilumab in CRSwNP patients.
• To assess the influence of surgical history on patient-reported outcomes, nasal polyp scores, and olfactory function.
• To compare Dupilumab efficacy in patients with and without prior ESS.

Main Methods:

• Retrospective, single-center, real-world study of adult CRSwNP patients treated with Dupilumab (2019-2025).
• Longitudinal data collection on patient-reported outcome measures (PROMs), nasal polyp score (NPS), and olfactory performance.
• Analysis using linear and piecewise linear mixed-effects models to compare outcomes based on surgical status.

Main Results:

• 224 patients were followed up to 4.5 years; 146 had prior ESS.
• Surgery-naïve patients presented with higher baseline disease burden.
• Dupilumab demonstrated significant improvements across all groups, with comparable long-term trajectories regardless of prior ESS, except for faster early improvement in PHQ-2 for surgery-naïve patients.

Conclusions:

• Dupilumab offers rapid, sustained clinical benefits for CRSwNP patients, irrespective of their prior endoscopic sinus surgery history.
• The study suggests surgical history does not significantly alter Dupilumab's long-term effectiveness.
• Further research is needed to assess the impact of surgical extent on treatment response.