(1210) Dupilumab in the Treatment of Severe-Uncontrolled Nasal Polyposis: A Two-Year Monocentric Experience in 80 Patients

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with significant morbidity and reduced health-related quality of life. Findings from clinical trials and phase-4 studies have demonstrated the effectiveness of dupilumab in CRSwNP.

Methods: This real-life, observational, monocentric study assessed the effectiveness and safety of dupilumab in patients with severe uncontrolled CRSwNP (n =  80) during a 30-month observation period, from May 2021 to December 2023. We collected data at baseline and after 1, 3, 6, 9, and 12 months of follow-up. After the first year, follow-up continues every semester. We focused on nasal polyps score (NPS), nasal symptoms, olfactory function (VAS score), and quality of life (SinoNasal Outcomes Test-22 [SNOT-22]). We considered comorbidities, previous surgery, and adherence to intranasal corticosteroids, and examined the success rates based on current guidelines.

Results: In total, 62 patients (77% of the population) exceed one year of therapy, while 31 patients (39%) reached the 2-year follow-up. Of the sample, 97% (78) still continues the treatment. We observed a significant decrease in NPS from a median value of 4.9 (SD 1,9) at baseline to 0.9 (SD 1.1) at 12 months (p < 0 .001), confirmed at 24 months in the 31-patient sample. A significant decrease in SNOT-22 scores was registered, from a median of 50.5 (SD 19.4) at baseline to 11.5 (SD = 11.6; p < 0.001) at 12 months; all data were confirmed at 24 months. Moreover, olfactory function and nasal symptoms VAS scores showed a significative improvement (p < 0 .005) at 1 and 2 years control, compared to baseline. An excellent-moderate response was observed in 92% patients, based on EPOS and EUFOREA criteria. Adverse effects were reported: no major were recorded, with quick resolution and without stopping the therapy.

Conclusions: Our findings support the effectiveness and safety of dupilumab as an add-on therapy in patients with severe uncontrolled CRSwNP in reducing polyp size and improving the quality of life, the severity of nasal symptoms, and olfaction.