The Utility of Intranasal Corticosteroids in Association With Dupilumab for Chronic Rhinosinusitis With Nasal Polyposis: A Real‐Life Multicenter Study by a Tuscany Group

Objective: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition often associated with other type-2 diseases. Dupilumab, a monoclonal antibody targeting IL-4Rα, has revolutionized the treatment of severe CRSwNP. Traditionally, intranasal corticosteroids (INCS) are used in association with Dupilumab, but their necessity remains uncertain. Methods: This real-life, multicentric observational study was conducted across seven centers in Tuscany, Italy, involving 123 patients with severe, uncontrolled type-2 CRSwNP treated with Dupilumab (300 mg/2 weeks) from January 2021 to December 2022. Parameters assessed included Sinonasal Outcome Test-22 (SNOT-22), Nasal Polyps Score (NPS), Sniffin' Sticks identification test (SSIT-16), and Lund-Mackay scores (LMS), along with blood eosinophil counts and adherence to INCS. Statistical analyses were performed to compare outcomes between INCS adherent and non-adherent groups. Results: A total of 123 patients, 53 men and 70 women with a mean age of 56.6 years were included. Significant improvements were observed in SNOT-22, NPS, SSIT, and LMS over 12 months. INCS adherence was incomplete in 23.8% of patients. Initially, non-adherent patients demonstrated a faster SNOT-22 reduction, while adherent patients showed better NPS and SSIT improvements early on. By 12 months, differences between groups were not statistically significant. No demographic or clinical factors predicted INCS adherence. Conclusion: Dupilumab is effective in managing type-2 CRSwNP, potentially without INCS. While INCS may hasten initial improvements, long-term outcomes are comparable with or without their use. Future randomized controlled trials are necessary to further clarify INCS's role in combination with Dupilumab.