Dupilumab for Chronic Rhinosinusitis with Nasal Polyps: A Critical Evidence-Based Review

Abstract

Objectives: Nasal polyps are present in a substantial proportion of patients with chronic rhinosinusitis (CRSwNP) and are driven, in most Western populations, by type 2 inflammation. Conventional treatment with corticosteroids and endoscopic sinus surgery frequently fails to provide durable disease control, particularly in patients with marked eosinophilia or comorbid asthma. This review examines dupilumab, a fully human monoclonal antibody directed against the interleukin-4 receptor alpha (IL-4Rα) subunit and the fir st biologic approved for this indication. Methods: We integrate disease immunobiology with dupilumab's pharmacology, the pivotal LIBERTY NP SINUS-24 and SINUS-52 trials, the head-to-head EVEREST trial, real-world data from the DUPIREAL and CHRINOSOR cohorts, safety records, comparative performance against the other approved biologic therapies, guideline positions, biomarker research, and cost-effectiveness analyses, drawing throughout on peer-reviewed sources identified by a database search covering January 2020 to June 2026, together with seminal earlier publications, including the pivotal trials, retrieved by hand-searching. Results: The evidence is consistent in direction. Olfaction recovers, polyp burden decreases, and patients require fewer systemic corticosteroid courses and revision procedures, with benefits that appear to persist over two to five years. Important uncertainties nevertheless remain: no single biomarker reliably predicts response, the optimal duration of therapy is undefined, and published analyses disagree on whether dupilumab is cost-effective relative to surgery. Conclusions: Biologic therapy is effective when guided by selective, criterion-based patient selection rather than applied as a routine first-line intervention.