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Choosing between dupilumab and surgery for chronic rhinosinusitis with nasal polyps (CRSwNP) isn't straightforward — the better option depends on when you're measuring. A large retrospective study found dupilumab patients needed fewer antibiotics and steroids in the first 6 months, but that advantage flipped after the 6-month mark. Polyp persistence or recurrence was consistently higher in the dupilumab group throughout follow-up.
When it comes to managing chronic rhinosinusitis with nasal polyps (CRSwNP), the choice between dupilumab and endoscopic sinus surgery isn't a simple one — and a new retrospective study of nearly 13,000 patients makes that clearer than ever. Researchers found that dupilumab offered early advantages: in the first 6 months, patients on the biologic were less likely to need oral antibiotics or steroids for sinusitis compared to those who had surgery. But after 6 months, the tables turned, with dupilumab-treated patients facing a higher risk of needing those same medications.
The polyp picture was even more telling. Dupilumab was associated with a significantly higher risk of polyp persistence or recurrence at both the early and late timepoints — more than double the risk after 6 months compared to surgery. Dupilumab patients also required more repeat imaging early on, though that risk dropped later in follow-up.
Key Takeaways:
Why it matters: These findings challenge the notion that dupilumab is a straightforward alternative to surgery. For clinicians managing CRSwNP, the data suggest that long-term outcomes — not just early relief — should drive treatment decisions.
