Drug1st-line biologic line

Dupilumab

Anti–IL-4Rα monoclonal antibody (blocks IL-4 and IL-13)

Response rate
~75% polyp reduction
Onset
4–8 weeks
Route
SC 300mg every 2 weeks
Line
1st-line biologic
IgM effect
Reduces polyp score by ~2 points (NPS)
Evidence level
green

Evidence summary

Blocks both IL-4 and IL-13 signalling via IL-4Rα. SINUS-24 and SINUS-52 trials demonstrated significant improvements in nasal polyp score (NPS), nasal congestion, Lund-Mackay CT score, SNOT-22, and olfaction (UPSIT). FDA-approved 2019. The most broadly effective biologic with consistent benefit across multiple outcomes.

Molecular targets

MoleculeRoleExpressionEvidence
IL-4Type 2 master cytokineElevatedestablished
IL-13Effector cytokine / tissue remodellerElevatedestablished

Sources (2)

T1Bachert C et al. (2019) Efficacy and safety of dupilumab in patients with severe CRSwNP (LIBERTY NP SINUS-24 and SINUS-52)DOI ↗
T5Fokkens WJ et al. (2020) EPOS/EUFOREA 2020 treatment algorithm for CRSwNPDOI ↗