The effect of decreasing the frequency of dupilumab administration after the first year on the control of chronic rhinosinusitis

Saleh Alali; Lana M. Saleh; Mohammed G. Aly; Sundus AlMukhodher; Rabea Khougeer

doi:10.18203/issn.2454-5929.ijohns20252981

Authors

Saleh Alali Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
Lana M. Saleh Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
Mohammed G. Aly Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
Sundus AlMukhodher Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
Rabea Khougeer Department of Allergy and Immunology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20252981

Keywords:

Dupilumab, Chronic rhinosinusitis, CRSwNP, Nasal polyps, Biologics, Type-2 inflammation, Treatment interval, SNOT-22, IgE, Eosinophils

Abstract

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) significantly impacts quality of life. Many studies have shown the effectiveness of dupilumab in controlling CRSwNP using bi-weekly protocol over the first year. However, the effect of spacing the dose beyond the first year remains unclear. This study aims to assess the efficacy of the increasing the interval of dupilumab administration in maintaining the effect achieved in the first year.

Methods: This prospective study includes CRSwNP patients receiving dupilumab for over a year who transitioned from a bi-weekly to a four-weekly regimen. Clinical response was assessed using nasal polyp size (NPS), sino-nasal outcome test-22 (SNOT-22), Lund-Mackay score (LMKS), serum immunoglobulin E (IgE) levels, and eosinophilic count at three time points: pre-treatment, during bi-weekly dosing, and after switching to four-weekly administration.

Results: A sustained clinical improvement was observed across all time points. NPS showed significant difference F (2, 30) =85.97, p<0.0001, generalized eta squared=0.73. similarly, SNOT-22 scores and LMKS exhibited significant differences F (1.33, 19.95) =58.55, p<0.0001, generalized eta squared =0.69 and F (1.29,19.4) =69.41, p<0.0001, generalized eta squared=0.59 respectively. IgE levels and eosinophilic count also showed significant variation F (2, 30) =101.5, p<0.0001, generalized eta squared=0.6 and F (2, 28) 9.37, p<0.0001, generalized eta squared=0.13.

Conclusion: Decreasing the frequency of administration of dupilumab after the first year is associated with a sustained disease control.

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