Letter to the Editor Regarding “Real‐world Predictors of Dupilumab Prescription in Patients With Chronic Rhinosinusitis With Nasal Polyps”

We congratulate Dorismond et al. [1] on their impactful study, " Real-world predictors of dupilumab prescription in patients with chronic rhinosinusitis with nasal polyps" published in the International Forum of Allergy & Rhinology. The study provides valuable insights into the factors influencing the prescription of dupilumab for chronic rhinosinusitis with nasal polyps (CRSwNP). However, several limitations should be addressed to strengthen the findings. First, a limitation of the study is its cross-sectional design and short follow-up period, which hinder the assessment of long-term outcomes such as recurrence, safety, and resistance. Longitudinal studies with multiple data points are necessary to track biomarkers and symptoms over time, while also exploring resistance mechanisms like antibody production. Expanding the sample size and conducting multicenter studies would enhance the robustness of the findings and provide deeper insights into long-term treatment effectiveness. Secondly, CRSwNP is a complex immune-mediated disease involving multiple inflammatory pathways, including Th1, Th17, and epithelial barrier dysfunction [2]. While the study focuses on Th2-driven inflammation, targeting a single pathway may not offer long-term control, particularly in complex cases. Integrating multiomics data to explore the interactions among these pathways and investigating combination therapies with dupilumab and other biologics or small molecules could enhance the comprehensiveness and sustainability of treatment strategies. Moreover, the study focuses on predicting medication use in surgical patients but lacks personalized analyses comparing surgery with pharmacotherapy alone, which limits its clinical applicability. To address this, a comprehensive efficacy evaluation model should be developed that incorporates patient-specific factors such as disease severity, biomarkers, and comorbidities. This model would optimize decision-making between surgery and biologic therapies, thereby enhancing clinical precision and improving treatment strategies. Additionally, the heterogeneity of the nasal polyp microenvironment can significantly influence treatment responses [3]. Techniques like immunohistochemistry and single-cell sequencing should be used to explore differences between nasal polyps and healthy tissue [4]. Studying the interplay between microenvironmental regulation and biologic therapies could provide valuable insights for personalized treatment and precision medicine. Last, the study emphasizes biological effects but overlooks improvements in quality of life. Incorporating tools such as the SNOT-22 and patient satisfaction measures would offer a more comprehensive evaluation [5]. Including patient-reported outcomes as core metrics would better capture real-world experiences, enhancing clinical relevance and informing treatment optimization. In conclusion, although the study provides valuable insights for clinical practice, further addressing its limitations is necessary to ensure broader applicability and clinical value. Longitudinal studies, multiomics integration, and personalized approaches will enhance the reliability of the findings. The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper. No datasets were generated or analyzed during the current study.