Efficacy and safety of dupilumab in chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis

Sim L 1 , Md Shukri N 1 , Yaacob NM 2 , Periasamy C 3 , Cornelia MG 4 , Abdullah B 1

Affiliations 

  • 1 Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
  • 2 Department of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
  • 3 Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Pulau Pinang, Georgetown, Pulau Pinang, Malaysia
  • 4 Saint Mary Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Expert Rev Clin Pharmacol, 2025 Feb 22.
PMID: 39960116 DOI: 10.1080/17512433.2025.2468970

Abstract

INTRODUCTION: Chronic rhinosinusitis with nasal polyps (CRSwNP) primarily displays type 2 inflammation, characterized by the activation of interleukin (IL)-4, IL-5, and IL-13 in the pathway. The purpose of this study is to determine the efficacy and safety of dupilumab (an IL-4 antagonist) in treating CRSwNP.

METHODS: A detailed search was performed in PubMed, Embase and the Cochrane Library databases. All published English-language randomized controlled trials (RCTs) that employed dupilumab to treat CRSwNP in adult patients (≥18 years old) were considered.

RESULTS: Three RCTs and 25 studies with 784 individuals were included. The use of dupilumab revealed improvement in polyp size (MD -1.80; 95% CI -2.25 to -1.36), Lund-Mackay score (MD -7.01, 95% CI -9.64 to -4.38), congestion (MD -0.86, 95% CI -0.99 to -0.73), smell (MD 10.83, 95% CI 9.59 to 12.08) and health-related quality of life (MD -19.61, 95% CI -22.53 to -16.69). Systemic corticosteroid use (RR 0.28, 95% CI 0.20-0.39) and revision surgery (RR 0.17, 95% CI 0.05-0.52) were reduced. Serious adverse events were reduced in dupilumab group (RR 0.47; 95% CI 0.29 to 0.76) with no change in risk of adverse events (RR 0.98, 95% CI 0.87 to 1.11).

CONCLUSIONS: Dupilumab is effective with minimal adverse events.

PROTOCOL REGISTRATION: www.crd.york.ac.uk/prospero identifier is CRD42023413004.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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