Dupilumab (Dupixent) for the treatment of chronic rhinosinusitis with nasal polyps

Dupilumab is available as a 300 mg ready-to-use syringe. It is used in addition to steroid nasal sprays (as an “add-on treatment”).

The first time it is used, 300 mg of the medication is injected under the skin (one 300 mg injection). This injection is then repeated every 2 weeks.

Patients can also inject themselves after being instructed how to do so by a doctor.

The effectiveness of the treatment should be monitored regularly. If the symptoms don’t improve after 24 weeks, doctors usually recommend stopping the treatment.

If treatment with steroid tablets or surgery hasn’t been effective enough, the standard treatment for chronic rhinosinusitis with nasal polyps is a steroid nasal spray containing budesonide or mometasone furoate. The treatment may be enhanced by taking measures such as nasal irrigation (flushing out the nose).

In 2020, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of dupilumab compared to the standard treatments for chronic rhinosinusitis with nasal polyps when steroid tablets or a surgical procedure have not been effective enough.

The manufacturer provided two studies for this assessment, and it was possible to analyze the results of the studies together: A total of 438 participants received dupilumab in addition to the standard treatment mometasone furoate, while 286 participants were given a standard treatment consisting of mometasone furoate and a placebo (fake medication).

After half a year, the study showed the following:

What are the advantages of dupilumab?

Symptoms of the illness and their effects: In the studies the patients were asked whether they experienced various symptoms of the illness and problems such as impaired sense of taste, dizziness, pain and trouble sleeping or concentrating, as well as how much of a burden they are. The study showed that dupilumab has an overall advantage here: The symptoms improved in 80 out of 100 people who also received dupilumab, compared to only 54 out of 100 people who were not given dupilumab.

The study also shows that dupilumab has an advantage regarding individual symptoms of the illness, such as a runny or stuffy nose and an impaired sense of smell.

Overall health: The patients were asked how they themselves would rate their overall health. The study shows that dupilumab has an advantage here too.

What are the disadvantages of dupilumab?

Dupilumab wasn’t found to have any disadvantages when used as an add-on treatment.

What remains unanswered?

Health-related quality of life: There was no data on health-related quality of life.

This information summarizes the main results of a review produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The review was commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of the review and the hearings received, the G-BA passed a resolution on the added benefit of dupilumab (Dupixent).