- The anti-IL4Rα monoclonal antibody dupilumab improves health-related QoL (HRQL), symptom severity, and need for surgery in severe chronic rhinosinusitis with nasal polyps, according to this Cochrane meta-analysis.
Why this matters
- First meta-analysis to analyze effects of biologics for the treatment of chronic rhinosinusitis, which affects about 11% of the UK population.
- Meta-analysis of 8 randomized controlled trials (RCTs; N=986) with at least 3 months' follow-up.
- Primary outcome was HRQL, disease severity, and serious adverse events (AEs).
- HRQL was measured by SinoNasal Outcome Test-22 (SNOT-22; scores 0-110 points, with lower scores indicating better outcome. Minimal clinically important difference was 8.9 points).
- Funding: All RCTs were industry sponsored.
- Most participants (n=784) were in 3 RCTs of dupilumab.
- At 24 weeks, the dupilumab patients had SNOT-22 scores 19.61 points lower (better) than control individuals:
- Mean difference (MD): −19.61 (95% CI, −22.54 to −16.69).
- Dupilumab patients had better symptom severity using a 0-10 point visual analogue scale:
- MD: −3.00 (95% CI, −3.47 to −2.53).
- Dupilumab patients had lower risk for serious adverse events:
- Risk ratio, 0.45 (95% CI, 0.28-0.75).
- Dupilumab patients had fewer actual or planned nasal polyp surgeries:
- Risk ratio: 0.17 (95% CI, 0.05-0.52).
- Results less certain with mepolizumab, omalizumab.
- Small number of studies, participants.