Dupilumab Monthly Dose De‐Escalation Maintains Efficacy in CRSwNP : A Two‐Year Real‐World Study

ABSTRACT Objective The aim of this study was to evaluate if dupilumab interval dose de‐escalation to every 4 weeks negatively impacts treatment outcomes in real‐life practice for severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) during the first 2 years of treatment. Methods We enrolled 148 patients who completed 2 years of follow‐up. We compared two homogenous groups in terms of severity: group A included 77 patients who never modified the interval of administration during follow‐up; group B included 71 patients who extended the dosing interval to monthly administration. We compared the treatment outcomes and differences in safety. Results The monthly interval dose prolongation was started in 22/71 patients (30.99%) at 6 months, in 11/71 (15.48%) at 9 months, in 22/71 (30.99%) at 12 months, and in 16/71 (22.54%) at 18 months. The dose prolongation was to manage minor adverse events in 9 of 71 patients; persistent eosinophilia in 26/71 patients; specific request of patients who had confirmed sustained control as determined by the physician's assessment in 36/71 cases. Mean values of all outcomes of response to treatment (i.e., volume of polyps, nasal obstruction, quality of life, olfaction) significantly improved at 6, 12, and 24 months compared to baseline ( p < 0.01) in both groups A and B. No significant differences were found comparing groups A and B for any of the outcomes examined over the 2 years of follow‐up ( p < 0.01). Conclusion These results suggest that extending to monthly dosing of dupilumab in real life does not negatively impact outcomes in patients with severe uncontrolled CRSwNP. Level of Evidence 3.