Is dupilumab (Dupixent) effective for treating nasal polyps?

Dupilumab is Highly Effective for Treating Nasal Polyps

Dupilumab (Dupixent) is highly effective for treating chronic rhinosinusitis with nasal polyps (CRSwNP), significantly improving nasal polyp burden, quality of life, and symptoms in patients with inadequately controlled disease. 1, 2

Efficacy of Dupilumab for Nasal Polyps

Dupilumab works by binding to the interleukin-4 receptor α (IL-4Rα) subunit, inhibiting both IL-4 and IL-13 signaling pathways, which are key drivers of type 2 inflammation involved in CRSwNP 2, 3. Multiple high-quality clinical trials have demonstrated its effectiveness:

• Significant improvements in multiple outcomes:

  • Reduction in nasal polyp score (NPS) 1
  • Improved quality of life (SNOT-22 scores) 1
  • Reduced rhinosinusitis disease severity (VAS) 1
  • Improved nasal congestion/obstruction 1
  • Enhanced sense of smell (UPSIT score) 1
  • Reduced sinus opacification on CT scans (Lund-Mackay score) 1
  • Improved lung function (FEV1) in patients with comorbid asthma 1

• Long-term benefits: Improvements were maintained at both 24 and 52 weeks in clinical trials 1

Patient Selection

Dupilumab is indicated for:

• Adult and pediatric patients aged 12 years and older 4
• Patients with inadequately controlled CRSwNP 2, 4
• Particularly beneficial for patients with:
  • High baseline disease severity
  • Comorbid asthma or atopic dermatitis
  • Inadequate response to intranasal corticosteroids or surgery 2
  • NSAID-exacerbated respiratory disease (NSAID-ERD) 5

Treatment Protocol

• Standard dosing: 300 mg subcutaneously every 2 weeks 1, 4
• Administration: Subcutaneous injection into thigh, abdomen, or upper arm 4
• Concomitant therapy: Continue intranasal corticosteroids during treatment 1, 2
  • Interestingly, recent research suggests dupilumab remains effective even with variable adherence to intranasal steroids 6

Safety Profile

Dupilumab is generally well-tolerated with a favorable safety profile:

• Common adverse effects:

  • Injection site reactions 2, 7
  • Nasopharyngitis 2, 7
  • Headache 2, 7

• Monitoring considerations:

  • Watch for eye symptoms (conjunctivitis, keratitis) 2
  • Monitor for hypersensitivity reactions 4
  • Be aware of potential eosinophilic conditions, especially when reducing oral corticosteroids 2, 4

Special Considerations

• Vaccinations: Complete all age-appropriate vaccinations prior to initiating treatment 2, 4
• Comorbid conditions: Particularly effective in patients with comorbid asthma, improving both upper and lower airway symptoms 1, 5
• Potential for extended dosing intervals: Recent research suggests that after achieving disease control, extending treatment intervals to 4 or even 6 weeks may be possible without clinical worsening, though this is not currently in the approved labeling 8

Clinical Pearls and Pitfalls

• Don't discontinue intranasal corticosteroids: Continue using them alongside dupilumab for optimal results 1, 2
• Monitor for eosinophilia: Transient increases in blood eosinophils can occur, particularly when reducing oral corticosteroids 4
• Don't use for acute symptoms: Dupilumab is not indicated for relief of acute bronchospasm or status asthmaticus 4
• Don't adjust asthma medications: Patients with co-morbid asthma should not adjust or stop their asthma treatment without consulting their healthcare provider 4

Dupilumab represents a significant advancement in the treatment of CRSwNP, offering substantial benefits for patients with inadequately controlled disease, particularly those with comorbid type 2 inflammatory conditions.