Prospective Real-World Outcomes of Endoscopic Sinus Surgery and Dupilumab in Severe Chronic Rhinosinusitis With Nasal Polyps

IF 4.9 2区医学 Q1 OTORHINOLARYNGOLOGY

International Forum of Allergy & Rhinology Pub Date : 2026-10-04 Epub Date: 2026-04-17 DOI:10.1002/alr.70163

Nirushan Narendran, Joseph Irish, Shireen Samargandy, Tara Carr, Christopher H. Le, Eugene H. Chang

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Abstract

Introduction

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease treated with endoscopic sinus surgery (ESS) or targeted biologic therapy such as dupilumab. Prospective real-world data guiding treatment decisions remain limited.

Materials and Methods

We conducted a single-center, prospective, real-world observational cohort study of adults with severe CRSwNP treated with ESS or dupilumab following structured shared decision-making. All patients met EPOS diagnostic criteria and were followed for 12 months. Standardized assessments were performed at baseline and every 3 months, including disease-specific quality of life (SNOT-22), olfaction (UPSIT-40), nasal congestion score (NCS), and endoscopic nasal polyp score (NPS). CRS exacerbations were prospectively monitored using biweekly symptom surveys, with endoscopic culture obtained during exacerbations with mucopurulence. Longitudinal outcomes were analyzed using mixed-effects models, and bacterial exacerbation incidence was evaluated using regression and survival analyses.

Results

Fifty adults completed 12-month follow-up (dupilumab, n = 20; ESS, n = 30). Both treatments resulted in significant improvements across patient-reported and objective outcomes, exceeding minimal clinically important differences. ESS was associated with more rapid early improvement, whereas dupilumab demonstrated more durable improvement in symptoms, olfaction, and nasal congestion. CRS exacerbations and culture-confirmed bacterial infections occurred less frequently in dupilumab-treated patients, with lower cumulative bacterial burden and longer infection-free survival. Staphylococcus aureus was the most common pathogen and more frequent among ESS-treated patients. Bacterial infection was associated with persistently higher symptom burden and worse longitudinal outcomes.

Conclusions

ESS and dupilumab both provide meaningful benefit in severe CRSwNP, with distinct temporal response patterns. Reduced exacerbations and bacterial infections—particularly S. aureus—were associated with more favorable disease trajectories, underscoring the importance of infection control in individualized treatment selection.

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内窥镜鼻窦手术和杜匹单抗治疗重度慢性鼻窦炎伴鼻息肉的前瞻性现实世界结果

慢性鼻窦炎伴鼻息肉（CRSwNP）是一种异质性炎症性疾病，可通过内镜鼻窦手术（ESS）或靶向生物治疗（如dupilumab）治疗。指导治疗决策的前瞻性真实世界数据仍然有限。材料和方法：我们进行了一项单中心、前瞻性、现实世界观察队列研究，在结构化的共同决策后，接受ESS或dupilumab治疗的严重CRSwNP成人患者。所有患者均符合EPOS诊断标准，随访12个月。在基线和每3个月进行标准化评估，包括疾病特异性生活质量（SNOT-22）、嗅觉（UPSIT-40）、鼻塞评分（NCS）和鼻息肉内镜评分（NPS）。通过两周一次的症状调查对CRS恶化进行前瞻性监测，并在粘膜脓性恶化期间进行内镜培养。采用混合效应模型分析纵向结果，采用回归分析和生存分析评估细菌恶化发生率。结果：50名成年人完成了12个月的随访（dupilumab, n = 20； ESS, n = 30）。两种治疗方法均显著改善了患者报告和客观结果，超过了最小的临床重要差异。ESS与更快速的早期改善相关，而dupilumab在症状、嗅觉和鼻塞方面表现出更持久的改善。在dupilumab治疗的患者中，CRS恶化和培养证实的细菌感染发生率较低，累积细菌负担较低，无感染生存期较长。金黄色葡萄球菌是最常见的病原体，在接受ess治疗的患者中更为常见。细菌感染与持续较高的症状负担和较差的纵向结果相关。结论：ESS和dupilumab对严重CRSwNP均有显著的疗效，且具有不同的时间反应模式。减少恶化和细菌感染（尤其是金黄色葡萄球菌）与更有利的疾病轨迹相关，强调了感染控制在个性化治疗选择中的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Forum of Allergy & Rhinology OTORHINOLARYNGOLOGY-

CiteScore

11.70

自引率

10.90%

发文量

185

审稿时长

6-12 weeks

期刊介绍： International Forum of Allergy & Rhinologyis a peer-reviewed scientific journal, and the Official Journal of the American Rhinologic Society and the American Academy of Otolaryngic Allergy. International Forum of Allergy Rhinology provides a forum for clinical researchers, basic scientists, clinicians, and others to publish original research and explore controversies in the medical and surgical treatment of patients with otolaryngic allergy, rhinologic, and skull base conditions. The application of current research to the management of otolaryngic allergy, rhinologic, and skull base diseases and the need for further investigation will be highlighted.