A comparison of Dupilumab and Mepolizumab for treating chronic rhinosinusitis with polyps (CRSwNP) was carried out by investigators at the University of Pittsburgh Medical Center, Department of Otolaryngology. Study findings were presented at the American Rhinologic Society (ARS) Annual Meeting (Philadelphia, PA, USA, September 9-10, 2022).
CRSwNP, chronic inflammation of the sinonasal tissue with polyp growths, affects 1.1–5.5 % of the general population. Most people with CRSwNP have type 2 inflammation, which is marked by high levels of molecules that cause inflammation, like interleukin-4 (IL-4) and IL-5. Recently, several biologics blocking IL-4 or IL-5 mediated pathogenesis have been introduced as an add-on treatment for type 2 inflammation. Mepolizumab, sold under the brand name Nucala, is an antibody used to block IL-5 signaling, and Dupilumab (dupixent) is a newer antibody targeting IL-4 signaling. Because these blockades inhibit different type 2 inflammatory signaling, a patient may benefit from more than one biologic. However, it is challenging in practice because no previous study has compared Dupilumab with mepolizumab for specific diseases.
Therefore, this study aims to compare the outcomes of Dupilumab and mepolizumab and their effectiveness in treating CRSwNP. This study included 21 patients aged 13 and up, 7 receiving mepolizumab and the remaining 14 receiving Dupilumab. Those who had received other biological treatment in the past were excluded. A retrospective chart review was performed on all the patients between 2021-2022 at the University of Pittsburg Medical Center Eye and Ear Institute.
The primary outcomes in this review were the change in nasal polyp score (NPS) and the SNOT-22 score. NPS is a physician-reported tool used to assess the extent/severity of nasal polyps using nasal endoscopy on the right and left nostrils. Each nostril is scored from 0 to 4, with a total score ranging from 0 to 8. SNOT-22 is a subjective questionnaire that measures how a nasal disease affects the health-related quality of life. It includes classic nasal and extra nasal symptoms; each item is scored between 0 (no problem) and 5 (worst possible problem). Secondary outcomes included improved asthma control and endoscopic sinus surgery (ESS).
According to the findings, the average duration of treatment for mepolizumab was 16 months, while Dupilumab was 13 months. Both NPS and SNOT-22 scores were significantly low for Dupilumab- or mepolizumab- treated patients who experienced a significant improvement in olfaction. Mepolizumab-treated patients, on the other hand, are more likely than Dupilumab-treated patients to require additional ESS. Besides, patients treated with mepolizumab had a higher rate of asthma improvement than patients treated with Dupilumab. Researchers concluded, “The overall results suggest that mepolizumab is much more effective at treating asthma, whereas Dupilumab has better clinical outcomes for CRSwNP management.”
Furthermore, up to 60 % of people with CRSwNP also have asthma (CRSwNP + AS), which is one of the most challenging subtypes to treat. When a person has CRSwNP + AS, their disease is worse, nasal polyps come back more often after surgery, asthma is harder to control, and it costs more. It seems likely that soon, the combination of Dupilumab and mepolizumab will be looked into as a way to treat people with CRSwNP + AS.