D3.431 - Dupilumab therapy of patients with chronic rhinosinusitis with nasal polyps: long-term observational study

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 (T2) immune-mediated disease that, despite symptomatic pharmacological and surgical management, is frequently associated with persistent impairment of quality of life. The treatment of difficult-to-manage endotypes has been substantially advanced by the introduction of biologic therapies. In Hungary, five years of real-world experience are available with dupilumab, which is considered the first-line biologic agent in this condition.

In this two-center retrospective study, 137 patients treated with dupilumab between October 2020 and January 2025 were included; among them, 107 patients had available follow-up data of at least six months. In accordance with current professional guidelines, the severity of nasal obstruction was assessed using a visual analogue scale, the extent of nasal polyposis by nasal endoscopy, olfactory dysfunction by symptom-based scoring, and quality of life using disease-specific questionnaire (Sinonasal Outcome Test-22).

The mean duration of treatment was 554.6 ± 355.3 days. The prevalence of T2-associated comorbidities was as follows: asthma in 105 patients (76.64%), nonsteroidal anti-inflammatory drug intolerance in 63 patients (45.99%), and allergic rhinitis in 69 patients (50.36%). Compared with baseline, all evaluated parameters showed statistically significant improvement at all follow-up time points (p < 0.001). Olfactory dysfunction—one of the most impactful determinants of quality of life—showed marked improvement in 71.96% of patients. Adverse events were observed in 25 cases (23.36%), and treatment discontinuation was required in 5 patients (3.65%). The most frequently reported adverse events were arthralgia and elevated serum eosinophil counts, followed by cutaneous and mucosal manifestations. In on third of patients, the dupilumab dose could be reduced without loss of therapeutic efficacy.

In this large-scale study with long-term follow-up, we demonstrated that dupilumab is significantly more effective than conventional treatment strategies and, when applied in accordance with established therapeutic guidelines, represents a safe and efficacious long-term treatment option for patients with CRSwNP