Should I continue taking Dupixent (dupilumab) for my severe asthma and chronic rhinosinusitis with nasal polyps?

Should You Continue Dupixent for Severe Asthma and Chronic Rhinosinusitis with Nasal Polyps?

Yes, you should continue taking Dupixent (dupilumab) for your severe asthma and chronic rhinosinusitis with nasal polyps, as it provides sustained, clinically meaningful improvements in both conditions with an excellent safety profile over long-term use. 1, 2, 3

Evidence Supporting Long-Term Continuation

Sustained Efficacy in CRSwNP

Dupilumab demonstrates progressive and sustained improvement in nasal polyp disease over 24 months of treatment. 3

• Nasal polyp scores decrease from a median baseline of 6 to 0 at 24 months, representing complete or near-complete resolution 3
• Quality of life (SNOT-22) improves dramatically from baseline scores of 62±19 to 15±11 at 6 months, with sustained benefits maintained below the minimal clinically important difference through 24 months 3
• Major symptoms including nasal obstruction, rhinorrhea, sleep disorders, and craniofacial pain show consistent and significant improvements through one year of treatment 3

Dual Benefit for Asthma and CRSwNP

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 confirms that dupilumab significantly improves both upper and lower airway outcomes simultaneously. 1

• Dupilumab treatment results in significant improvements in FEV1 (lung function) and asthma control (ACQ scores) compared to placebo 1
• These asthma benefits occur regardless of baseline eosinophil count 2
• The Joint Task Force on Practice Parameters 2023 ranks dupilumab as superior to other biologics for quality of life, symptoms, smell improvement, decreased need for oral corticosteroids, and decreased need for surgery 1

Comparative Effectiveness Data

Network meta-analysis demonstrates dupilumab's superiority over other biologic options for your dual condition. 1

• For quality of life: dupilumab > omalizumab > mepolizumab > benralizumab 1
• For symptom control: dupilumab > omalizumab > mepolizumab 1
• For smell restoration: dupilumab > mepolizumab > omalizumab > benralizumab 1
• For reducing oral corticosteroid need: dupilumab > mepolizumab > benralizumab 1

Safety Profile Supporting Continuation

Dupilumab's adverse event profile is not significantly different from placebo, supporting long-term safety. 1, 2

• The most common adverse events are mild to moderate in severity 2
• No significant safety concerns emerge with extended treatment duration up to 24 months 3
• The FDA label confirms safety and effectiveness in adults for both asthma and CRSwNP indications 4

Continuation Strategy

Standard Dosing Regimen

Continue dupilumab 300 mg subcutaneously every 2 weeks as the evidence-based standard regimen. 1, 4, 2

• This dosing schedule is FDA-approved and supported by phase III trial data 4, 2
• Both 24-week and 52-week studies demonstrate sustained efficacy at this interval 1, 2

Concomitant Therapy Optimization

Maintain intranasal corticosteroids alongside dupilumab for optimal upper airway control. 1, 5

• Intranasal corticosteroids (such as mometasone furoate) can be safely combined with dupilumab without drug interactions 5
• The European Rhinologic Society recommends this combination approach for CRSwNP 5
• Continue your asthma controller medications as prescribed; do not adjust or stop asthma treatments without consulting your healthcare provider 4

Monitoring Parameters

Track these specific outcomes to confirm ongoing treatment benefit:

• Nasal symptom scores (congestion, discharge, smell) should show sustained improvement 1, 3
• Quality of life (SNOT-22 scores) should remain below your baseline by at least 8-10 points 1
• Asthma control should be maintained or improved (reduced exacerbations, stable or improved lung function) 1, 2
• Reduction in need for oral corticosteroid rescue courses 1, 2

Critical Considerations

Do Not Discontinue Corticosteroids Abruptly

Never stop systemic or inhaled corticosteroids without direct physician supervision, as this may cause withdrawal symptoms or disease flare. 4

• Reduction in corticosteroid dose may unmask conditions previously suppressed by systemic corticosteroid therapy 4
• Any corticosteroid tapering should be gradual and physician-directed 4

Avoid Live Vaccines During Treatment

Vaccination with live vaccines is not recommended while receiving dupilumab. 4

• Inform all healthcare providers that you are taking dupilumab prior to any potential vaccination 4
• Inactivated vaccines can be administered safely 4

Watch for New-Onset Conditions

Report any new joint symptoms or skin changes to your healthcare provider. 4

• Cases of new-onset psoriasis and psoriatic arthritis have been reported with dupilumab use 4
• These are uncommon but require medical evaluation if they occur 4

When Continuation Is Most Strongly Indicated

Your specific combination of severe asthma and CRSwNP represents the ideal phenotype for dupilumab continuation. 1, 6, 2

• Patients with both conditions demonstrate improvements in upper and lower airway outcomes simultaneously 1, 2
• The unified airway inflammation characteristic of your presentation responds optimally to IL-4/IL-13 blockade 6, 2
• Treating both conditions with a single biologic is more effective than treating each condition independently 6