How effective are biologics like Dupilumab for nasal polyps?

Question

Hi doctor,

I have had chronic sinus issues for a long time, including constant stuffiness, a lack of sense of smell, and pressure around my eyes. Recently, an ENT specialist diagnosed me with nasal polyps and mentioned that I might need surgery.

I have tried both steroid nasal sprays and oral steroids, but the relief is only temporary. Is surgery the only real solution?

I am also concerned that the polyps will return after treatment. Are biologic treatments, such as Dupixent, effective for this condition? I have mild asthma as well, so I would like to know if there is a connection. I am just tired of feeling like I am breathing through a sponge all day.

Do you have any lifestyle tips that might help prevent flare-ups after treatment?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

Surgery can be effective in alleviating the symptoms of nasal polyps; however, polyps often recur, particularly if the underlying inflammation is not managed.

Biologic therapies like Dupixent (Dupilumab) have demonstrated efficacy in reducing polyp size and maintaining symptom relief, especially in patients with coexisting asthma.

To help reduce flare-ups after treatment, lifestyle measures such as avoiding irritants, managing allergies, using nasal saline rinses, and maintaining humidified air can be beneficial.

Functional endoscopic sinus surgery (FESS) can significantly improve symptoms and quality of life by removing polyps, restoring sinus drainage, and allowing better access for medications post-surgery. Nonetheless, nasal polyps recur in about 40 to 60% of patients within one to two years after surgery, particularly in those with severe inflammation or asthma.

Surgery is generally recommended when medical therapy fails to provide lasting relief, but it does not eliminate the underlying inflammatory condition causing the polyps.

Dupilumab is an injectable biologic approved for treating chronic rhinosinusitis with nasal polyps and asthma. It targets key inflammation pathways that are central to polyp formation.

Clinical trials and recent studies indicate that Dupixent can reduce polyp size, improve nasal airflow and sense of smell, and alleviate asthma symptoms. It is particularly useful when steroid treatments are insufficient or when surgery is not preferred or has proven ineffective.

Recurrence of polyps is often due to chronic inflammation; thus, controlling this inflammation is crucial for prevention. Patients with asthma, allergies, or aspirin sensitivities are at a higher risk of polyp recurrence. Ongoing medical management after surgery, which may include nasal corticosteroids and possibly biologics, is frequently required.

I suggest these tips to prevent flare-ups.

Use saline nasal rinses daily to keep the nasal passages moist and clear of irritants.
Avoid tobacco smoke, strong perfumes, chemical fumes, and allergens.
Manage asthma and allergies effectively with prescribed medications. Keep indoor air humidified using a humidifier to prevent nasal dryness and irritation.
Maintain good hand hygiene to reduce the risk of infections.
Consider dietary changes that emphasize anti-inflammatory foods and stress management to support immune health.

While surgery can physically remove polyps and improve symptoms, it often requires additional treatment to control inflammation and prevent recurrence. Dupixent is an effective biologic option for refractory cases, particularly in patients with asthma. Lifestyle adjustments also play a significant role in maintaining nasal health and minimizing flare-ups after treatment.

I hope this answers your query. Feel free to reach out anytime.

Thank you.