The increasing rate of dupilumab use is associated with the reduction of endoscopic sinus surgery (EES) for chronic rhinosinusitis with nasal polyps (CRSwNP), according to a new study presented at the 2023 American Rhinologic Society, Combined Otolaryngology Spring Meeting (ARS-COSM) held in Boston, Massachusetts, May 3-5.
A team of researchers led by Christopher M. Low, MD, from Stanford University School of Medicine, investigated how the rates of conventional treatment (oral corticosteroids and EES) for CRSwNP may have changed after the FDA approval of dupilumab for CRSwNP. In addition, the research team evaluated differences in demographics between patients who were already using dupilumab compared to patients undergoing EES during the same period.
The study compared the rates of oral corticosteroids prescription, dupilumab prescription, and EES for Nasal Polyps (NP) patients diagnosed between Aug 2017- Mar 2021. Demographic data, including patients’ gender, date of birth, and address, were collected. For categorical variables for statistical significance analysis, chi-square testing, post hoc testing, and multivariate logistic regression were utilized.
Study results showed that the rates of dupilumab prescriptions in NP patients increased from 0.28% to 2.48% in the 11 months after the FDA approval. At the same time, the rates of EES decreased from 18.5% to 15.9%. Moreover, no significant alterations were found in EES and dupilumab utilization rates regarding patients’ age, gender, asthma, or atopic dermatitis. “The significant rise in dupilumab prescriptions coupled with a concurrent decline in the utilization of EES highlights a promising shift in treatment preferences,” the author added.
Regarding the geographical characteristics, the study found significant variation in patterns of dupilumab prescription by geographic area, with the greatest percentage found in the Western and Northeast states of the US. In addition, the rural areas were more likely to utilize EES than urban states (having greater dupilumab prescription utilization).
However, the authors acknowledged that the impact of the concurrent COVID-19 pandemic could be the potential confounder on the surgery utilization rates, with warranted longer-term utilization trends. Furthermore, dupilumab patients are more likely to experience comorbid asthma or atopic dermatitis, signifying that dupilumab can be a more favorable initial treatment option for this group. Taking it all together, the shift in increasing rates of dupilumab prescriptions and declining utilization of EES holds promise for improved outcomes and enhanced quality of life, and reduce overall healthcare cost for patients struggling with CRSwNP.
CRSwNP is an inflammatory disease of the nasal cavity and paranasal sinuses, resulting in nasal congestion, loss of smell, and other symptoms. Dupilumab is an FDA-approved monoclonal antibody directed against IL-4 and IL13. It is the first of its biologic class to be approved for treating CRSwNP patients and can potentially impact and change already available treatment algorithms. However, more real-world data regarding its utilization and impact is needed compared to traditional treatment options.
Reference:
Low CM, Wang AR, Yong M, Nayak J, Patel Z, Hwang P. Impact of Dupilumab Prescribing on Utilization of Medical and Surgical Therapies for Chronic Rhinosinusitis with Nasal Polyps. ARS-COSM, May 4-5, 2023.