Dupilumab in chronic rhinosinusitis with nasal polyposis: current status, challenges, and future perspectives

ABSTRACT

Introduction

Chronic sinusitis with nasal polyposis (CRSwNP) is a common heterogeneous disease that mainly manifests as chronic inflammation of the sinus mucosa. The effect of conventional treatments for CRSwNP, such as oral corticosteroids, intranasal corticosteroids (INCS) and polypectomy, is not always obvious, and postoperative recurrence is common in some CRSwNP patients. In recent years, some biologics have been shown to be very effective in treating refractory CRSwNP, of which dupilumab has attracted much attention as the first monoclonal drug approved to treat nasal polyps.

Areas covered

In this review, we discuss the research status of dupilumab in treatment of CRSwNP and how dupilumab differs from other treatment methods.

Expert opinion

The European Union and United States have approved dupilumab as the first biological agent for treatment of CRSwNP. Dupilumab can improve symptoms of nasal congestion or obstruction, nasal secretion, and olfactory loss in patients with CRSwNP. It can also improve a patient’s health-related quality of life (HR-QoL) and reduce the need for systemic corticosteroids and nasal polyp surgery. While subcutaneous injection of dupilumab is a novel method for treating CRSwNP, it is still necessary to reasonably evaluate which patients might benefit most from biological therapy.

KEYWORDS:

• Biologic therapy
• Chronic rhinosinusitis with nasal polyposis
• Dupilumab
• Type 2 inflammation
• Eosinophils

Article highlights

1. As a new treatment method, biological agents can effectively target one or more biomarkers involved in the pathogenesis of CRSwNP for precise treatment.

2. Dupilumab can significantly reduce the levels of most biomarkers of type 2 inflammation by inhibiting the IL-4 and IL-13 signaling pathways, and then improve HRQoL of CRSwNP patients.

3. The high cost of biological agents necessitates the careful selection of patients, and the proper use of biotherapy requires further investigation.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors thank all the staff from Department of Otolaryngology, Head and Neck Surgery.

Additional information

Funding

The research was supported by the National Natural Science Foundation of China (82271146 and 82271147) and the Major Scientific and Technological Innovation Project of Shandong Province (2020CXGC011302 and 2022CXGC020506)