D1.452 - Remission as a therapeutic goal in chronic rhinosinusitis with nasal polyps treated with Dupilumab: a multicenter real-world study

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease associated with significant impairment in quality of life. Biologic therapies have transformed disease management, potentially enabling complete disease control beyond symptom improvement. EPOS and EUFOREA introduced the concept of clinical remission in CRSwNP, and the Rhinosinusitis Italian Network (RINET) proposed Delphi-based criteria defining complete and partial remission. However, these criteria have not yet been validated in real-world clinical practice.

We conducted a retrospective multicenter study including adult patients with severe refractory CRSwNP treated with dupilumab between March 2021 and July 2025 across five Italian centers. Clinical remission at 12 months was defined according to RINET criteria: absence of systemic corticosteroids and surgery, SNOT-22 <20, olfactory VAS ≤3, and strict endoscopic thresholds (NPS=0 for complete remission; NPS≤2 for partial remission). Treatment response was evaluated according to EPOS/EUFOREA 2023 criteria. Logistic regression analysis was performed to identify independent predictors of remission.

At 12 months, 30.2% of patients achieved at least partial remission, including 18.3% achieving complete remission. Nearly all patients reached at least a moderate response, and more than two-thirds achieved a good response according to EPOS/EUFOREA criteria. Significant and progressive improvements in endoscopic scores, quality of life, and symptom burden were observed during follow-up. Lower baseline nasal polyp score and early improvement in polyp burden and olfactory dysfunction independently predicted remission.

In this large real-world cohort of severe CRSwNP, dupilumab induced deep and progressive clinical improvement. Remission appears to be an achievable therapeutic target in routine practice, supporting the disease-modifying potential of dupilumab. Further studies are needed to identify clinical and molecular predictors of remission.