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Effectiveness of dupilumab versus endoscopic sinus surgery for the treatment of type-2 chronic rhinosinusitis with nasal polyps: a preliminary report

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Historically managed with intranasal corticosteroids (INCS) and endoscopic sinus surgery (ESS), type-2 Chronic RhinoSinusitis with Nasal Polyps (CRSwNP) treatment was revolutionized by the introduction of dupilumab but universally accepted guidelines are still lacking.

Methods

Patients treated at our University Hospital for type-2 CRSwNP were enrolled. Demographic data were collected, as well as laboratory (eosinophils, total IgE), endoscopic [nasal polyps score (NPS), modified Lund–Kennedy score (mLKS)], radiological [Lund–Mackay score (LMS) at CT scan], SNOT-22, and olfactory [Sniffin’ Sticks identification test (SSIT)] features. Patients were treated with dupilumab or ESS and re-evaluated after 3 and 12 months.

Results

At 3 and 12 months, patients undergoing ESS achieved a higher reduction of NPS and mLKS, while patients receiving dupilumab experienced a higher improvement at SNOT-22 and SSIT with a greater positive variation in the prevalence of anosmia (− 57.7% vs − 42.9%) and normosmia (+ 37.8 vs + 28.5%). Mean mLKS and LMS were quite similar. Results were independent of clinical features known to contribute to CRSwNP severity, except for patients with ≥ 2 prior ESS who had a significantly lower smell improvement.

Conclusion

ESS and dupilumab were effective at reducing CRSwNP inflammatory burning. CRSwNP smell impairment cannot be attributed only to olfactory cleft obstruction and other mechanisms may be involved. Dupilumab acts systemically with poor correlation with NPS. As of today, dupilumab appears to be more suitable for elderly patients with anesthesiological contraindications and/or several previous surgeries, while ESS may represent the first-line choice in surgery-naive patients.

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Acknowledgements

We would like to give thanks to all the patients who agreed to participate in the present study and to all the healthcare personnel of the Otorhinolaryngology Department of Careggi University Hospital, Florence (Italy) who helped us in the surgical and in-patient activities.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Careggi University Hospital, Florence-Largo Brambilla, 3-50134, Florence, Italy

    Pietro Orlando, Giuseppe Licci, Donald Kuitche, Oreste Gallo & Giandomenico Maggiore

  2. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Oreste Gallo

  3. Immunoallergoly Unit, Careggi University Hospital, Florence-Largo Brambilla, 3-50134, Florence, Italy

    Andrea Matucci & Alessandra Vultaggio

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  1. Pietro Orlando
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Correspondence to Pietro Orlando.

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Orlando, P., Licci, G., Kuitche, D. et al. Effectiveness of dupilumab versus endoscopic sinus surgery for the treatment of type-2 chronic rhinosinusitis with nasal polyps: a preliminary report. Eur Arch Otorhinolaryngol 281, 1317–1324 (2024). https://doi.org/10.1007/s00405-023-08309-x

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