Real world efficacy of dupilumab in switchers versus biological naive CRSwNP patients.

[en] BACKGROUND: Biologicals have revolutionized care for severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). Currently, real-world efficacy (RWE) data of dupilumab in patients who switch to dupilumab after having no or minimal therapeutic response to either omalizumab or mepolizumab are lacking. No comparison has been performed between patients switching from omalizumab or mepolizumab to dupilumab and those receiving dupilumab as their first biological.
AIM: 55 CRSwNP patients receiving dupilumab in the RELIBIO trial were divided into those who were biological naive (n = 30) and those who showed no to poor therapeutic response to 6 months therapy with either omalizumab or mepolizumab (n = 25), with evaluation of the following parameters at baseline and 6 months: SNOT-22 scores, nasal congestion scores (NCS), VAS scores for nasal obstruction, smell loss and postnasal drip, ACQ-5, AQLQ and total nasal polyp scores (TNPS). We determined disease control and therapeutic response evaluation (TRE) at 6 months for both groups using the EUFOREA/EPOS criteria.
RESULTS: Dupilumab showed significant improvements on all patient-reported outcome measures (PROMs) and TNPS in both groups. When comparing the efficacy between switchers and naive patients, dupilumab showed equal efficacy in both groups on SNOT-22, TNPS, NCS, VAS scores for smell loss, nasal blockage and postnasal drip, ACQ-5 and AQLQ. A good to excellent therapeutic response at 6 months was observed in 67% of switchers compared to 97% of the biological naive patients. Regarding disease control at 6 months, we observed 44% being controlled in the switchers and 67% in the biological naive group, with smell loss being the main reason for not being controlled.
CONCLUSIONS: This prospective RWE study shows that dupilumab significantly reduced symptom severity and nasal polyp scores in CRSwNP patients at 6 months of therapy, also in those showing a minimal therapeutic response to mepolizumab or omalizumab. Patients in the biologic naive group showed a higher likelihood of achieving disease control.