De-escalation of dupilumab for chronic rhinosinusitis with nasal polyps: analysis of outcomes after modified dosing regimen.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition with severe impacts on quality of life and substantial economic costs (1,2). Dupilumab targeting the underlying T2 inflammation in CRSwNP showed promising results; however, it is unknown if intensive regimens must be maintained in responders to prevent relapse (3,4). In 2019, FDA and the European Commission approved Dupilumab 300 mg administered subcutaneously every two weeks for CRSwNP. We hypothesized that disease control might be maintained by reducing the frequency of administration in patients who initially well answered to the standard treatment (3,4). To date the benefit of de-escalation was only analyzed in short time (5). We wanted to understand if a de-escalation regimen could be introduced without compromising disease control in long follow-up; to this aim we de-escalated Dupilumab at 300 mg every four weeks following a year of conventional bi-weekly administration.