Introduction
Chronic rhinosinusitis with nasal polyps (CRSwNP) affects 3-6% of the population, heavily impacting quality of life. Improved understanding of CRSwNP has identified type 2 inflammation as a key driver, associated with higher recurrence rates. Dupilumab, targeting IL-4 and IL-13 pathways, was the first biologic approved in Germany for CRSwNP in 2019. This retrospective study explores changes in prescription patterns, demographics, and clinical characteristics at a German tertiary center post-dupilumab introduction.
Methods
Patients initiating dupilumab between 2019 and 2023 were grouped into four cohorts based on the year of treatment initiation, with a minimum follow-up of six months. A total of 174 patients were included: 60 in 2019/20, 58 in 2021, 33 in 2022, and 23 in 2023.
Results
Across all cohorts, age remained consistent, with a mean of 47.6-49.7 years. Gender distribution was predominantly male until 2023, where females constituted 56.5% of patients. A significant decline in prior surgical interventions was noted, with patients undergoing more than three sinus surgeries decreasing from 28.3% in 2019/20 to 13.0% in 2023. The prevalence of extensive sinus surgeries decreased over time from 3.0 in 2020 to 2.3 in 2023.
Discussion
Despite consistent demographics and disease severity, a reduction in extensive surgical histories suggests a shift toward earlier biologic use. The decline in new dupilumab prescriptions post-2021 highlights strict guideline adherence, ensuring only severely affected patients receive therapy. Adhering to these guidelines is crucial given dupilumab"s high cost, balancing clinical benefits with the need for economic sustainability in healthcare.
Patrick Huber hat keine Interessenskonflikte anzugeben.