Evaluation of extended dupilumab dosing intervals Q2W (biweekly) versus Q4W (monthly) in chronic rhinosinusitis with nasal polyposis: a real-world study from Saudi Arabia : Extended dupilumab dosing in CRSwNP.

Abstract

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP), often Linked to asthma, significantly affects quality of life. While dupilumab 300 mg every two weeks (Q2W) is effective, it is costly. This real-world Saudi study evaluated whether extending dosing to every four weeks (Q4W) maintains effectiveness in patients with or without asthma.

Methods: In this retrospective single-cohort study, 42 adults with CRSwNP who completed at least one year of stable Q2W dupilumab therapy were transitioned to Q4W and followed for one additional year. Clinical, biomarker, and imaging outcomes were analyzed.

Results: Clinical outcomes between Q2W and Q4W were largely comparable. Eight CRSwNP patients had comorbid asthma (19%). Median nasal polyp scores remained stable, and symptom scores for nasal congestion, discharge, smell loss, and fatigue showed no significant changes. Sino-Nasal Outcome Test (SNOT)-22 and Lund-Mackay scores trended lower in the Q4W group compared to Q2W group but were not statistically significant. Blood eosinophils were modestly reduced, while asthma control remained stable, with high asthma control test scores. Total IgE levels (IU/mL) were significantly lower in the Q4W group (32.5 [10.1-76.4] vs. 52.7 [19.8-215], p<0.001), suggesting immunologic benefit. Fractional exhaled nitric oxide (FeNO) levels were unchanged. Overall, 92.9% maintained symptom control on Q4W for one year; three reverted to Q2W due to worsening of asthma control symptoms.

Conclusion: Transitioning from Q2W to Q4W dupilumab dosing is effective for most CRSwNP patients, including those with asthma, after one year of stable therapy. This approach may reduce treatment burden without compromising clinical outcomes.