Work

Early real-life outcomes of dupilumab and mepolizumab in patients with uncontrolled primary diffuse type 2 chronic rhinosinusitis

Year: 2025

Type: article

Abstract: PURPOSE: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease causing significant morbidity. Biologics such as dupilumab (anti-IL-4Ra) and mepolizumab (anti-IL-5) are effective treatments; however, comparative real-world data remain limited. This study evaluates their effectiveness over the first six months in patients with uncontrolled primary diffuse Type 2 chronic rhinosinusitis. METHODS: A retrospective analysis was conducted on 85 CRSwNP patients treated at Padova University Hospital (58 dupilumab, 27 mepolizumab). Patient-reported (SNOT-22, VAS scores) and clinician-reported (NPS, SSIT, PNIF) outcomes were assessed at baseline (T0), one month (T1), three months (T3), and six months (T6). RESULTS: Dupilumab showed a rapid and significant improvement in all assessed PROMs and CROMs (p < 0.001), with a marked reduction in nasal polyp size and superior early olfactory recovery. By six months, 17% of dupilumab-treated patients achieved normosmia versus 7% in the mepolizumab group. Mepolizumab improved most outcomes except VAS-smell and significantly reduced blood eosinophil counts (p < 0.001), whereas dupilumab had no significant effect. According to EUFOREA 2023 criteria, 70% of dupilumab-treated patients had a moderate to excellent response versus 37% in the mepolizumab group. CONCLUSION: Both biologics are effective for CRSwNP, but their efficacy profiles differ. Dupilumab provides faster olfactory and nasal polyp improvements. Personalized biologic selection is essential, and further studies are needed to define long-term outcomes.

Source: European Archives of Oto-Rhino-Laryngology

DOI: 10.1007/s00405-025-09725-x