Use of Nasal Nitric Oxide to Compare Endoscopic Sinus Surgery Versus Dupilumab: An Exploratory Real-World Comparison.

Objective: To compare the outcomes of endoscopic sinus surgery (ESS) and dupilumab using nasal nitric oxide (nNO) as a biomarker of mucosal health, Lund-Kennedy endoscopy score (LKES), and Sino-Nasal Outcome Test-22 (SNOT-22).

Methods: A prospective observational cohort of chronic rhinosinusitis with nasal polyposis (CRSwNP) patients who underwent ESS followed by standard postoperative therapy was compared with another prospective cohort of CRSwNP patients who received dupilumab. In addition to baseline characteristics, nNO production, LKES, and SNOT-22 levels were compared between the 2 cohorts at the 1st month and 6th month posttreatment.

Results: A total of 28 and 37 patients were included in the ESS cohort and the dupilumab group, respectively. At the 1stmonth and 6th month posttreatment, nNO levels were comparable between 2 groups. Compared to baseline, the ESS cohort showed increased nNO levels at 1st month posttreatment, while the dupilumab group did not. At the 6th month posttreatment, both groups exhibited a significant increase in nNO levels. Similar trend was observed in LKES. SNOT-22 decreased at the 1st month and 6th month posttreatment compared with that in baseline.

Conclusion: ESS and dupilumab confer comparable benefits in terms of nNO changes, symptoms, and endoscopy findings at the 6th month posttreatment. ESS may result in more rapid improvement in the outcomes than in dupilumab as evidenced by the 1 month posttreatment values.