High Response Rates and Predictors in Patients with CRSwNP Treated With Mepolizumab and Dupilumab: Results From a Prospective, Multicenter Cohort Study.

BackgroundDupilumab and mepolizumab are effective add-on therapies for severe chronic rhinosinusitis with nasal polyps (CRSwNP). However, predictors of response and guidance on biologic selection remain limited. The aims were to identify baseline parameters associated with favorable response to dupilumab or mepolizumab at 6 and 12 months in severe CRSwNP and compare outcomes among treatments.MethodsWe conducted a multicenter, prospective, non-randomized, real-world cohort study across three tertiary hospitals in Spain. Patients with severe CRSwNP initiating dupilumab or mepolizumab were enrolled and followed at 6 and 12 months. Response was defined using EPOS/EUFOREA 2023 criteria, incorporating nasal polyp score (NPS), sinonasal outcome test (SNOT-22), total symptom score (TSS), olfaction (Sniffin' Sticks Smell Test), systemic corticosteroid need, and asthma control test. Patients were classified as excellent, good, poor, or non-responders based on criteria fulfilled.ResultsSixty-nine patients were included: 35 received dupilumab and 34 mepolizumab. Asthma was present in 86.8%, and 42.6% had aspirin-exacerbated respiratory disease. Both biologics improved SNOT-22, TSS and NPS at 6 and 12 months (P < .05), with comparable efficacy for most outcomes. Dupilumab showed superior improvement in olfaction (coefficient B [95% CI] mepolizumab vs dupilumab: -6.30 [-9.42; -3.19]). Overall, 84.2% of patients achieved a good/excellent response at 6 months and 89.6% at 12 months. Factors associated with better response included comorbid asthma and shorter time since last surgery.ConclusionsDupilumab and mepolizumab improved clinical outcomes in severe CRSwNP, with dupilumab offering greater benefit in olfaction. Asthma and surgical history may help predict response.