D2.451 - Real-life upper and lower airway outcomes of long-term dupilumab treatment in patients with severe chronic rhinosinusitis with nasal polyps

Severe chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with significant burden of disease, including high prevalence of asthma and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD), as well as a need for repeated surgical interventions and systemic corticosteroid (SCS) treatment. This real-world retrospective study aimed to describe the long-term outcomes of dupilumab treatment of severe, uncontrolled CRSwNP.

Finnish patients who were part of the population-based FinnGen registry and received dupilumab treatment for severe uncontrolled CRSwNP between February 2018 and January 2025 were included in the analysis. The demographics and CRSwNP disease burden, treatment persistence, as well as the real-life effectiveness of up to 4 years of dupilumab treatment were evaluated.

The study involved 142 severe CRSwNP patients (median age 54.1 years) with a mean disease duration of 13.8 years before dupilumab initiation (Table 1). Most patients (87%) had concomitant asthma and 28% had N-ERD. Almost all (97%) patients had a history of sinus surgery, and 32% had undergone >3 prior surgeries. Further, 97% of patients had a history of OCS usage, with 20 % having used ≥5 courses of OCS in the prior 2 years. Mean follow-up time on dupilumab treatment was 2.1 years; for 122 patients (86%), at least 2 years of follow-up data was available and for 9 patients (6%), 4-year follow-up data was available. More than 85% of the patients stayed on treatment until the end of follow-up. Patients were well controlled on dupilumab treatment: only one patient (<1%) had rescue surgery during follow-up. Further, the need for SCS was reduced: no SCS had been used by 66% of patients at 2 years on dupilumab, while the respective proportion for the 2 years before dupilumab initiation was 18%. Additionally, in patients with concomitant asthma and available baseline and follow-up data, mean FEV1 increase of +0.2 L from baseline was observed both at 12 months (n=33) and 24 months (n=37) after dupilumab initiation.

In this real-world, retrospective study with up to 4 years of follow-up, dupilumab reduced the need for rescue interventions and demonstrated a high level of treatment persistence in patients with severe CRSwNP, most of whom had also asthma or asthma and N-ERD. Additionally, dupilumab treatment provided long-term improvement of lung-function in patients with comorbid asthma. These findings support the use of dupilumab for the long-term management of CRSwNP in clinical practice.