Abstract
In patients with severe, uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP), dupilumab 300 mg every 2weeks can completely resolve nasal polys, sinus disease, and symptoms. In this case, patients ask for de-escalation. Although trials have demonstrated recurrence after stopping the biologic at 24weeks, reducing the dose of dupilumab to once every 4weeks did not result in deterioration of control. An extension of the treatment intervals would, however, diverge from the approval text, and is currently not recommended. The course of 29patients with severe CRSwNP, type‑2 inflammation-associated comorbidities, and an indication for biologic was retrospectively analyzed. After resolution of CRSwNP and symptoms under biweekly dupilumab 300 mg, the dupilumab interval had been prolonged individually, initially up to 4weeks, thereafter up to 6weeks, if applicable. Control was assessed via quality of life (22-item sinonasal outcome test, SNOT-22), nasal polyp score, and smell identification test (Sniffin' Sticks; Burghart Messtechnik, Holm, Germany). All patients showed an excellent improvement within the first 3months. The dupilumab application interval was extended to 4weeks after 7-31months (median 13months) and to 6weeks (n = 9) after 17-35months (median 23months). No recurrent polyps or symptoms were subsequently observed. In case of maximal regression of polyps and discomfort, extension of dupilumab injection intervals to4 and potentially 6weeks is possible without clinical worsening. Further studies on de-escalation or termination of biologic treatment when CRSwNP control is achieved are essential.
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