Effectiveness of Dupilumab Treatment to Treat Chronic Rhinosinusitis With Nasal Polyposis: A Systematic Review and Meta-Analysis.

Abstract

Background and objectives: Evidence bearing on the safety and efficacy of dupilumab treatment for chronic rhinosinusitis with nasal polyps (CRSwNP) has recently been presented by researchers from various institutions. Therefore, we compared the safety and efficacy of dupilumab treatment to those of endoscopic sinus surgery.

Methods: The PubMed, Scopus, Embase, Web of Science, and Cochrane databases were searched independently by two authors from the dates of their inception to December 2022. We retrieved the clinical results of CRSwNP patients after dupilumab administration, including changes in patient symptoms and the effects on the quality of life, and compared the results of dupilumab (treatment group) to those of endoscopic sinus surgery (control group).

Results: Eight articles (1,251 patients) were ultimately included. Dupilumab significantly improved nasal symptoms (nasal congestion) (mean difference [MD], -1.4433; 95% confidence interval [CI], -1.7233 to -1.1632; I²=94.2%), the visual analog sinusitis score (MD, -5.0506; 95% CI, -5.4744 to -4.6267; I²=84.0%), olfactory function (standardized MD, 1.2691; 95% CI, 1.1549 to 1.3833; I²=18.4%), the quality of life (SNOT-22 score) (MD, -34.4941; 95% CI, -39.4187 to -29.5695; I²=90.8%), the Lund-Mackay computed tomography score (MD, -7.2713; 95% CI, -8.9442 to -5.5984; I²=87.7%), and the nasal polyp score (MD, -3.1021; 95% CI, -3.7066 to -2.4977; I²=95.6%) at about 12 months after treatment compared to the pretreatment values. Compared to endoscopic sinus surgery, dupilumab similarly improved olfactory function (MD, 1.9849; 95% CI, -1.6190 to 5.5888; I²=0.0%) but was less effective in terms of reducing the SNOT-22 score (MD, 3.8472; 95% CI, 1.9872 to 5.7073; I²=96.7%) and reducing nasal congestion (MD, 0.6519; 95% CI, 0.5619 to 0.7420; I²=97.7%).

Conclusion: Dupilumab reduced subjective symptom scores and improved the quality of life and objective measures of progression compared to the preoperative values.