Xolair, Dupixent and Nucala all have the indication to treat chronic rhinosinusitis with nasal polyps. Conventional treatment involves nasal surgery (debulking polypectomy and sinus surgery to create open sinus cavities and improve ostiomeatal complex drainage). Many patients relapse despite medical and surgical treatment.
3 current medications are used to target type 2 inflammation to improve disease control.
An indirect comparison from phase 3 placebo controlled trials were studied in an article titled “The Choice of Biologics in Patients with Severe Chronic Rhinosinusitis with Nasal Polyps.”
The relative improvements of nasal polyp scores saw a reduction with each of these medications:
- Nucala (mepolizumab) 15% reduction
- Xolair (omalizumab) 18% reduction
- Dupixent (dupilumab) 35% reduction
So Dupixent performed better in improving the the Nasal Polyp Scores.
Total nasal endoscopic polyp score (TPS) Endoscopic scoring system Ranges 0-8. 0 = no polyps, 1 = polyps confined to the middle meatus, 2 = multiple polyps occupying the middle meatus, 3 = polyps extending beyond middle meatus, 4 = polyps completely obstructing the nasal cavity.
This trend was mirrored by relative improvements in health status with the 22 item Sinonasal Outcome Test score showing:
- Nucala 21% reduction
- Xolair 27% reduction
- Dupixent 43% reduction
The 22-item Sinonasal Outcome Test (SNOT-22) is a validated patient-reported outcome measure for chronic rhinosinusitis and in many circumstances is used in rhinology/otolaryngology clinics to assess sinonasal symptoms in general.
All showed a significant improvement. All biologics improved nasal airway blockage and also reduced the need for rescue medical/and or surgical polypectomy.
The greater objective and subjective responses to Dupixent versus either Nucala or Xolair might reflect its effect on the type 2 pathway by blocking IL-4 and IL-13, suppressing IgE and FeNO, suggesting a more broader spectrum of action. All 3 of them reduced the need for rescue medication and nasal polyp surgeries.
The University of Pennsylvania Smell Identification Test (UPSIT), is a measure of sense of smell, with a higher value reflecting a better sense of smell.