Sinus Surgery vs. Dupilumab for Chronic Rhinosinusitis with Nasal Polyps: A Look at the Trends
Using the Epic Cosmos database, researchers in the Department of Otorhinolaryngology at UTHealth Houston examined the use of the monoclonal antibody dupilumab as a therapy for chronic rhinosinusitis with nasal polyps (CRSwNP) in more than 1.8 million patients treated at multiple institutions. They found that over the three-year period between May 2020 and April 2023, prescriptions written for dupilumab increased significantly – at a rate of .01% a month – while the percentage of patients who had undergone sinus surgery 12 months before starting the biologic medication decreased substantially.
“Sinus surgery is still considered the first line of treatment for CRSwNP. It’s far less expensive than treatment with dupilumab, which costs between $20,000 and $30,000 annually,” says Amber Luong, MD, PhD, professor and vice chair for academic affairs in the department. “More than 70% of patients with CRSwNP require only one surgery. Dupilumab is not curative and ideally should be used in patients who don’t respond to surgery. For some of these recalcitrant patients, the biologic does offer a pronounced resolution.”
The research also revealed that the percentage of patients prescribed dupilumab increased at a higher rate for allergists compared to pulmonologists and ENTs. “Our results suggest that the use of dupilumab without a preceding sinus surgery for recurrent nasal polyps may be increasing, particularly in patients managed by our nonsurgical colleagues,” Dr. Luong says. “These patients may have had surgery earlier, but because EPIC is relatively new, the COSMOS database doesn’t allow us to look back further than a year. We want to continue to follow this trend because of the implications for health care utilization and cost. With more prescriber data, we can further explore these relationships.”
Second-year medical student Daniel Xiao, who helped analyze the data, presented the paper at the American Rhinologic Society Spring Meeting held in May 2024 in Chicago.