Dupilumab helps people with severe chronic rhinosinusitis

Dupilumab helps people with severe chronic rhinosinusitis

Vanessa Jordan
Clinical question

Are biologics effective for the treatment of chronic rhinosinusitis?

Bottom line

All of the drugs were evaluated in adults with chronic rhinosinusitis and nasal polyps who were also using regular topical nasal steroids. In these patients, the review found high‐certainty evidence from 3 studies (with nearly 800 partici­pants) that dupilumab results in a large improvement in disease‐specific health‐related quality of life (HRQL) compared with placebo, and a large reduction in the extent of the disease as measured on a CT scan.

Moderate‐certainty evidence showed that dupilum­ab probably also results in a large improvement in symptoms, increases generic HRQL (as measured by overall health status) and results in a large re­duction in the size of polyps (as measured by nasal polyp scores). It probably results in a large reduction in the need for further surgery, but the clinical im­plications of this finding are difficult to interpret due to methodological limitations. There may be little or no difference in the risk of nasopharyngitis.

Mepolizumab has been evaluated in similar pa­tients, but the certainty of evidence is either low or very low. It may improve both disease‐specific and generic HRQL. It may also improve nasal polyp scores, but the evidence is very uncertain.

The review identified moderate‐certainty evidence from 2 studies that omalizumab probably results in a large improvement in disease‐specific HRQL compared with placebo. It may also result in a large reduction in the need for surgery, but the evidence for this was of low certainty.


All but one study recruited patients with moderate to severe chronic rhinosinusitis with na­sal polyps, and at least half of the participants also had asthma as a comorbidity. Therefore, there is no evidence on whether patients with less severe dis­ease (with or without nasal polyps or asthma) would benefit as much or at all.

There is a lack of long‐term evidence. While treatment with biologics is arguably a lifetime com­mitment, only one study had a 52‐week follow-up, which reduces the ability to determine if the effect size is maintained or if there is a higher risk of side effects in the long term.


Chronic rhinosinusitis is common. It is characterised by inflammation of the nasal and sinus linings, nasal blockage, rhinorrhoea, facial pressure/pain and loss of sense of smell. It occurs with or without nasal polyps. Biologics are medic­inal products produced by a biological process. Monoclonal antibodies are one type already evalu­ated in other inflammatory conditions (eg, asthma and atopic dermatitis).

Cochrane Systematic Review

Chong LY, et al. Bi­ologics for chronic rhinosinusitis. Cochrane Data­base Syst Rev 2020;2(2):CD013513. This review contains 10 trials with a total of 1262 participants.