Use of dupilumab as adjuvant therapy in patients with previous sinus surgery for uncontrolled chronic rhinosinusitis with nasal polyps: a systematic review
DOI:
https://doi.org/10.18203/2320-6012.ijrms20252033Keywords:
Chronic rhinosinusitis, Sinus surgery, Nasal polyps, DupilumabAbstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease of the nose and sinuses where most patients undergo surgery, however, postoperative recurrence of nasal polyps is common resulting in multiple re-interventions. Biological therapies such as dupilumab have been developed to suppress the inflammatory pathways involved in this disease. The aim of the present review is to evaluate the impact of the use of dupilumab in patients with uncontrolled CRSwNP, and its effect on the frequency of revision surgeries. A bibliographic search was performed in PubMed, Cochrane and Google Scholar. included articles published between 2019 and 2024, meta-analyses, systematic reviews, randomized controlled trials, studies in adult population, and the use of dupilumab in patients with previous sinus surgery. The quality of evidence was assessed using GRADE. Seven studies were included, totaling 1603 patients with uncontrolled CRSwNP, 84.6% of the total patients had a history of having undergone at least one surgery, after completion of follow-up, dupilumab demonstrated a reduction in the frequency of revision surgeries in addition to an improvement in sinonasal symptoms. Existing evidence supports the benefit of the use of dupilumab as an adjuvant therapy in patients with uncontrolled CRSwNP due to the reduction in the frequency of revision surgeries. Further studies addressing the effect of dupilumab in the short-term postoperative period are needed to compare the results obtained.
Metrics
References
Ostovar A, Fokkens WJ, Vahdat K, Raeisi A, Mallahzadeh A, Farrokhi S. Epidemiology of chronic rhinosinusitis in Bushehr, southwestern region of Iran: a GA2LEN study. Rhinology. 2019;57(1):43-8. DOI: https://doi.org/10.4193/Rhin18.061
Hirsch AG, Nordberg C, Bandeen-Roche K, Tan BK, Schleimer RP, Kern RC, et al. Radiologic sinus inflammation and symptoms of chronic rhinosinusitis in a population-based sample. Allergy. 2020;75(4):911-20. DOI: https://doi.org/10.1111/all.14106
Bayar Muluk N, Cingi C, Scadding GK, Scadding G. Chronic Rhinosinusitis-Could Phenotyping or Endotyping Aid Therapy? Am J Rhinol Allergy. 2019;33(1):83-93. DOI: https://doi.org/10.1177/1945892418807590
Tomassen P, Vandeplas G, Van Zele T, Cardell LO, Arebro J, Olze H, et al. Inflammatory endotypes of chronic rhinosinusitis based on cluster analysis of biomarkers. J Allergy Clin Immunol. 2016;137(5):1449-56. DOI: https://doi.org/10.1016/j.jaci.2015.12.1324
Stevens WW, Peters AT, Hirsch AG, Nordberg CM, Schwartz BS, Mercer DG, et al. Clinical Characteristics of Patients with Chronic Rhinosinusitis with Nasal Polyps, Asthma, and Aspirin-Exacerbated Respiratory Disease. J Allergy Clin Immunol Pract. 2017;5(4):1061-70. DOI: https://doi.org/10.1016/j.jaip.2016.12.027
Robinson D, Humbert M, Buhl R, Cruz AA, Inoue H, Korom S, et al. Revisiting Type 2-high and Type 2-low airway inflammation in asthma: current knowledge and therapeutic implications. Clin Exp Allergy. 2017;47(2):161-75. DOI: https://doi.org/10.1111/cea.12880
Promsopa C, Kansara S, Citardi MJ, Fakhri S, Porter P, Luong A. Prevalence of confirmed asthma varies in chronic rhinosinusitis subtypes. Int Forum Allergy Rhinol. 2016;6(4):373-7. DOI: https://doi.org/10.1002/alr.21674
Wang M, Bu X, Luan G, Lin L, Wang Y, Jin J, et al. Distinct type 2-high inflammation associated molecular signatures of chronic rhinosinusitis with nasal polyps with comorbid asthma. Clin Transl Allergy. 2020;10:26. DOI: https://doi.org/10.1186/s13601-020-00332-z
Bhattacharyya N, Villeneuve S, Joish VN, Amand C, Mannent L, Amin N, et al. Cost burden and resource utilization in patients with chronic rhinosinusitis and nasal polyps. Laryngoscope. 2019;129(9):1969-75. DOI: https://doi.org/10.1002/lary.27852
Gill AS, Smith KA, Meeks H, Oakley GM, Curtin K, LeClair L, et al. Asthma increases long-term revision rates of endoscopic sinus surgery in chronic rhinosinusitis with and without nasal polyposis. Int Forum Allerg Rhinol. 2021;11(8):1197-206. DOI: https://doi.org/10.1002/alr.22779
Lou H, Zhang N, Bachert C, Zhang L. Highlights of eosinophilicchronic rhinosinusitis with nasal polyps in definition, prognosis, and advancement. Int Forum Allergy Rhinol. 2018;8:1218-25. DOI: https://doi.org/10.1002/alr.22214
Lourijsen ES, Reitsma S, Vleming M, Hannink G, Adriaensen GFJPM, Cornet ME, et al. Endoscopic sinus surgery with medical therapy versus medical therapy for chronic rhinosinusitis with nasal polyps: a multicentre, randomised, controlled trial. Lancet Respir Med. 2022;10(4):337-46. DOI: https://doi.org/10.1016/S2213-2600(21)00457-4
De Corso E, Settimi S, Tricarico L, Mele DA, Mastrapasqua RF, Di Cesare T, et al. Predictors of Disease Control After Endoscopic Sinus Surgery Plus Long-Term Local Corticosteroids in CRSwNP. Am J Rhinol Allergy. 2021;35(1):77-85. DOI: https://doi.org/10.1177/1945892420936196
Khan A, Vandeplas G, Huynh TMT, Joish VN, Mannent L, Tomassen P, et al. The Global Allergy and Asthma European Network (GALEN rhinosinusitis cohort: a large European cross-sectional study of chronic rhinosinusitis patients with and without nasal polyps. Rhinology. 2019;57(1):32-42. DOI: https://doi.org/10.4193/Rhin17.255
Smith KA, Orlandi RR, Oakley G, Meeks H, Curtin K, Alt JA. Long-term revision rates for endoscopic sinus surgery. Int Forum Allergy Rhinol. 2019;9:402-8. DOI: https://doi.org/10.1002/alr.22264
De Corso E, Bellocchi G, De Benedetto M, Lombardo N, Macchi A, Malvezzi L, et al. Biologics for severe uncontrolled chronic rhinosinusitis with nasal polyps: a change management approach. Consensus of the Joint Committee of Italian Society of Otorhinolaryngology on biologics in rhinology. Acta Otorhinolaryngol Ital. 2022;42(1):1-16. DOI: https://doi.org/10.14639/0392-100X-N1614
Bachert C, Bhattacharyya N, Desrosiers M, Khan AH. Burden of Disease in Chronic Rhinosinusitis with Nasal Polyps. J Asthma Allergy. 2021;14:127-34. DOI: https://doi.org/10.2147/JAA.S290424
Han JK, Bosso JV, Cho SH, Franzese C, Lam K, Lane AP, et al. Multidisciplinary consensus on a stepwise treatment algorithm for management of chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol. 2021;11(10):1407-16. DOI: https://doi.org/10.1002/alr.22851
Gevaert P, Lee SE, Settipane RA, Wagenmann M, Msihid J, Siddiqui S, et al. Dupilumab provides early and durable improvement of symptoms in patients with chronic rhinosinusitis with nasal polyps. Clin Transl Immunology. 2023;12(1):e1433. DOI: https://doi.org/10.1002/cti2.1433
Calus L, Van Bruaene N, Bosteels C, Dejonckheere S, Van Zele T, Holtappels G, et al. Twelve-year follow-up study after endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyposis. Clin Transl Allergy. 2019;9:30. DOI: https://doi.org/10.1186/s13601-019-0269-4
DeConde AS, Mace JC, Levy JM, Rudmik L, Alt JA, Smith TL. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope. 2017;127(3):550-5. DOI: https://doi.org/10.1002/lary.26391
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464. DOI: https://doi.org/10.4193/Rhin20.601
Fokkens W, Van Der Lans R, Reitsma S. Dupilumab for the treatment of chronic rhinosinusitis with nasal polyposis. Expert Opin Biol Ther. 2021;21(5):575-85. DOI: https://doi.org/10.1080/14712598.2021.1901881
Thibodeaux Q, Smith MP, Ly K, Beck K, Liao W, Bhutani T. A review of dupilumab in the treatment of atopic diseases. Hum Vaccin Immunother. 2019;15(9):2129-39. DOI: https://doi.org/10.1080/21645515.2019.1582403
Le Floc'h A, Allinne J, Nagashima K, Scott G, Birchard D, Asrat S, et al. Dual blockade of IL-4 and IL-13 with dupilumab, an IL-4Rα antibody, is required to broadly inhibit type 2 inflammation. Allergy. 2020;75(5):1188-204. DOI: https://doi.org/10.1111/all.14151
Gandhi NA, Pirozzi G, Graham NMH. Commonality of the IL-4/IL-13 pathway in atopic diseases. Expert Rev Clin Immunol. 2017;13:425-37. DOI: https://doi.org/10.1080/1744666X.2017.1298443
Hopkins C, Lund V. Does Time from Previous Surgery Predict Subsequent Treatment Failure in Chronic Rhinosinusitis with Nasal Polyps? Rhinology. 2021;59:277-83. DOI: https://doi.org/10.4193/Rhin21.017
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020; statement: an updated guideline for reporting systematic reviews. BMJ. 2021;n71. DOI: https://doi.org/10.1136/bmj.n71
Alicandri-Ciufelli M, Marchioni D, Pipolo C, Garzaro M, Nitro L, Dell’Era V, et al. Influence of Prior Endoscopic Sinus Surgery Extent on Dupilumab Effectiveness in CRSwNP Patients. The Laryngoscope. 2024;134(4):1556-63. DOI: https://doi.org/10.1002/lary.30983
De Corso E, Pasquini E, Trimarchi M, La Mantia I, Pagella F, Ottaviano G, et al. Dupilumab in the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP): A multicentric observational Phase IV real-life study (DUPIREAL). Allergy. 2023;78(10):2669-83. DOI: https://doi.org/10.1111/all.15772
Jansen F, Becker B, Eden JK, Breda PC, Hot A, Oqueka T, et al. Dupilumab (Dupixent®) tends to be an effective therapy for uncontrolled severe chronic rhinosinusitis with nasal polyps: real data of a single-centered, retrospective single-arm longitudinal study from a university hospital in Germany. Eur Arch Otorhinolaryngol. 2023;280(4):1741-55. DOI: https://doi.org/10.1007/s00405-022-07679-y
van der Lans RJL, Otten JJ, Adriaensen GFJPM, Hoven DR, Benoist LB, Fokkens WJ, et al. Two-year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months. Allergy. 2023;78(10):2684-97. DOI: https://doi.org/10.1111/all.15796
Ottaviano G, Saccardo T, Roccuzzo G, Bernardi R, Chicco AD, Pendolino AL, et al. Effectiveness of Dupilumab in the Treatment of Patients with Uncontrolled Severe CRSwNP: A “Real-Life” Observational Study in Naïve and Post-Surgical Patients. J Pers Med. 2022;12(9):1526. DOI: https://doi.org/10.3390/jpm12091526
De Corso E, Settimi S, Montuori C, Corbò M, Passali GC, Porru DP, et al. Effectiveness of Dupilumab in the Treatment of Patients with Severe Uncontrolled CRSwNP: A “Real-Life” Observational Study in the First Year of Treatment. J Clin Med. 2022;11(10):2684. DOI: https://doi.org/10.3390/jcm11102684
Bachert C, Han JK, Desrosiers M, Hellings PW, Amin N, Lee SE, et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet. 2019;394(10209):1638-50. DOI: https://doi.org/10.1016/S0140-6736(19)31881-1
Gallo S, Russo F, Mozzanica F, Preti A, Bandi F, Costantino C, et al. Prognostic value of the Sinonasal Outcome Test 22 (SNOT-22) in chronic rhinosinusitis. Acta Otorhinolaryngol Ital. 2020;40(2):113-21. DOI: https://doi.org/10.14639/0392-100X-N0364
Kosinski M, Nelsen L, Rizio AA, Lay-Flurrie J, von Maltzahn R, Jacques L, et al. Psychometric properties of the Asthma Control Test in 2 randomized clinical trials. J Allergy Clin Immunol Pract. 2021;9(1):561-3. DOI: https://doi.org/10.1016/j.jaip.2020.07.040
Hopkins C, Wagenmann M, Bachert C, Desrosiers M, Han JK, Hellings PW, et al. Efficacy of dupilumab in patients with a history of prior sinus surgery for chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol. 2021;11(7):1087-101. DOI: https://doi.org/10.1002/alr.22780
Scangas GA, Wu AW, Ting JY, Metson R, Walgama E, Shrime MG, et al. Cost Utility Analysis of Dupilumab Versus Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyps. Laryngoscope. 2021;131(1):E26-33. DOI: https://doi.org/10.1002/lary.28648
Dessouky O, Hopkins C. Surgical versus medical interventions in CRS and nasal polyps: comparative evidence between medical and surgical efficacy. Curr Allergy Asthma Rep. 2015;15:66. DOI: https://doi.org/10.1007/s11882-015-0566-5
Downloads
Published
How to Cite
Issue
Section
