Switching to dupilumab from other biologic therapies in chronic rhinosinusitis with nasal polyps (CRSWNP): a comparison with biologic-naïve patients

Purpose: Data on the impact of previous biologic treatment on the effectiveness of dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma are still limited. This study aimed to compare clinical outcomes of dupilumab in patients previously treated with asthma-targeted biologics who switched to dupilumab due to inadequate disease control, versus biologic-naïve patients. Methods: This study was designed as a retrospective matched case-control study within the Italian DUPIREAL network, including patients with severe CRSwNP and severe asthma, all treated with dupilumab. Among these, we identified 44 consecutive patients with severe uncontrolled CRSwNP and asthma who initiated dupilumab after asthma-targeted biologics (Group A) and compared them with biologic-naïve CRSwNP and asthma patients receiving dupilumab as their first biologic treatment (Group B, n = 44), matched 1:1 at baseline based on asthma severity (according to GINA classification). Clinical, endoscopic, olfactory, asthma-related, and laboratory parameters were assessed at baseline and during a 24-month follow-up. Results: Baseline clinical characteristics were comparable between groups. Dupilumab treatment led to a marked and sustained improvement in all the analyzed outcomes in both groups without any significant differences in clinical outcomes at any follow-up timepoint. Among patients who switched to dupilumab, those with well-controlled asthma at baseline did not experience any deterioration in asthma control, whereas patients with uncontrolled asthma showed a significant improvement in asthma control during dupilumab therapy. Although blood eosinophil counts increased more frequently in the switching group from 12 months onward, no negative impact on clinical outcomes, safety, or treatment discontinuation was observed, with comparable adverse event rates between groups. Conclusions: Dupilumab was equally effective in patients with CRSwNP and asthma regardless of previous biologic treatment. Switching from other asthma-targeted biologics did not lead to loss of asthma control, and switchers more frequently developed eosinophilia without an associated increase in adverse events or treatment discontinuation.