From the Guidelines
Dupixent (dupilumab) is the most effective treatment option for patients with nasal polyps, including those with negative allergy testing, due to its ability to reduce type 2 inflammation and improve quality of life, symptoms, and smell, as shown in the most recent guidelines 1. When considering treatment options for nasal polyps, it's essential to weigh the benefits and risks of each therapy. The joint task force on practice parameters grade guidelines for the medical management of chronic rhinosinusitis with nasal polyposis 1 provides a comprehensive comparison of different treatments, including intranasal corticosteroids (INCS), biologics, and aspirin desensitization and treatment (ATAD).
- Key points to consider when evaluating Dupixent for nasal polyps include:
- Its effectiveness in improving quality of life, symptoms, and smell, as demonstrated in clinical trials 1
- Its ability to reduce the need for oral corticosteroids and surgery 1
- Its safety profile, which shows no significant difference in adverse effects compared to placebo 1
- Its high cost and need for long-term treatment, which may be a consideration for some patients 1
- In patients with negative allergy testing, Dupixent's mechanism of action, which targets interleukin-4 and interleukin-13 signaling, can still provide benefits by reducing type 2 inflammation that contributes to nasal polyp formation 1.
- The standard dosing for adults with nasal polyps is 300mg given subcutaneously every two weeks after an initial loading dose, and patients should continue their intranasal corticosteroids during treatment, as recommended by the guidelines 1.
- Common side effects of Dupixent include injection site reactions, conjunctivitis, and rarely eosinophilia, which should be monitored and managed accordingly 1.
- Insurance coverage often requires documentation of previous treatment failures, including surgery and/or systemic corticosteroids, highlighting the importance of careful patient selection and treatment planning 1.
From the Research
Dupixent and Nasal Polyps
- Dupixent (dupilumab) is a fully human IgG4 monoclonal antibody against the interleukin (IL)-4 receptor α (IL-4Rα) subunit, which is shared by the type I IL-4 and the type II IL-4/IL-13 receptor complexes 2.
- It has been approved for the treatment of adults with inadequately controlled chronic rhinosinusitis with nasal polyps (CRSwNP) in the EU and the USA 2.
Efficacy of Dupixent in Patients with Nasal Polyps
- Dupixent has been shown to significantly improve objective and patient-reported measures of CRSwNP, including loss of smell, and reduce systemic and nasal biomarker levels versus placebo at week 24, with no significant treatment difference between patients with and those without allergic rhinitis (AR) 3.
- It has also been demonstrated to reduce polyp size, sinus opacification, and severity of symptoms, and was well tolerated in adult patients with severe CRSwNP 4.
Use of Dupixent in Patients with Negative Allergy Testing
- There is no direct evidence in the provided studies that specifically addresses the use of Dupixent in patients with nasal polyps and negative allergy testing.
- However, the studies suggest that Dupixent is effective in patients with CRSwNP, regardless of their allergy status 3.
Comparison with Other Treatments
- Depemokimab, an ultra-long-acting biological drug, has also been shown to be effective in reducing nasal polyp scores and improving symptoms in patients with CRSwNP, with a twice per year dosing regimen 5.
- The efficacy and safety of dupilumab as an adjuvant treatment after endoscopic sinus surgery for CRSwNP has also been demonstrated, with significant improvements in endoscopic scores and nasal polyp scores 6.