Efficacy and safety of dupilumab in chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis
Abstract
ABSTRACT Introduction Chronic rhinosinusitis with nasal polyps (CRSwNP) primarily displays type 2 inflammation, characterized by the activation of interleukin (IL)-4, IL-5, and IL-13 in the pathway. The purpose of this study is to determine the efficacy and safety of dupilumab (an IL-4 antagonist) in treating CRSwNP. Methods A detailed search was performed in PubMed, Embase and the Cochrane Library databases. All published English-language randomized controlled trials (RCTs) that employed dupilumab to treat CRSwNP in adult patients (≥18 years old) were considered. Results Three RCTs and 25 studies with 784 individuals were included. The use of dupilumab revealed improvement in polyp size (MD −1.80; 95% CI −2.25 to −1.36), Lund-Mackay score (MD −7.01, 95% CI −9.64 to −4.38), congestion (MD −0.86, 95% CI −0.99 to −0.73), smell (MD 10.83, 95% CI 9.59 to 12.08) and health-related quality of life (MD −19.61, 95% CI −22.53 to −16.69). Systemic corticosteroid use (RR 0.28, 95% CI 0.20–0.39) and revision surgery (RR 0.17, 95% CI 0.05–0.52) were reduced. Serious adverse events were reduced in dupilumab group (RR 0.47; 95% CI 0.29 to 0.76) with no change in risk of adverse events (RR 0.98, 95% CI 0.87 to 1.11). Conclusions Dupilumab is effective with minimal adverse events. Protocol registration www.crd.york.ac.uk/prospero identifier is CRD42023413004.
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 784 participants or records.
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