Can Dupilumab prevent my nasal polyps recurrence at 42?

Question

Hello doctor,

I am a 42-year-old man with chronic sinus congestion and reduced smell for over a year. My ENT (ear-nose-throat) said I have nasal polyps on both sides and prescribed a steroid spray, which helped only temporarily. My recent CT (computed tomography) scan showed partial sinus blockage. Please tell me;

Would endoscopic surgery be a better long-term option?
Are biologic injections like Dupilumab effective in preventing recurrence?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Endoscopic sinus surgery (ESS) is widely considered a highly effective long-term treatment for chronic rhinosinusitis with nasal polyps, especially in cases where medical therapies like steroid sprays have only provided temporary relief or partial improvement. The success rate of this procedure ranges from 76 to 98 percent.

However, certain risk factors such as

Asthma.
Aspirin sensitivity.
Severe polyps.

These may increase the chance of polyp recurrence after surgery.

Biologic therapy Dupilumab was approved for adults with chronic rhinosinusitis with nasal polyps who remain symptomatic despite standard therapy. Both ESS and dupilumab are effective at improving symptoms.

But their comparative long-term results show some important differences: Functional endoscopic sinus surgery offers more rapid relief of congestion, polyp size, and overall symptoms for several months after the procedure.

Dupilumab is highly effective in reducing recurrence, especially if you are suffering from type 2 inflammatory profiles such as;

Eosinophilia.
Asthma.
Allergic rhinitis.

However, once the biologic is stopped, polyps may eventually recur. Surgery remains the first line of treatment in most cases, especially since it is much less costly compared to long-term biologic therapy. Recovery is typically within a few weeks, with most patients experiencing substantial and sustained improvement.

Dupilumab is reserved for patients who do not respond well to surgery or have frequent recurrences or those with severe comorbidities. Its disadvantages are;

Regular injections.
Cost factor.
Its effects may be reduced if treatment is discontinued.

Endoscopic sinus surgery is usually recommended as the best initial long-term option for most patients with chronic nasal polyps, including those with partial sinus blockage. You should discuss personal risk factors, cost implications, and comorbidities in detail with your ENT to decide the ideal approach for your situation.

I hope this information helps you.

Feel free to ask further queries.

Thank you.