Dupilumab Eases Sinonasal Symptoms in Chronic Rhinosinusitis Without Polyps

Dupilumab improved patient-reported outcome scores compared with placebo in adults with moderate-to-severe chronic rhinosinusitis without nasal polyps (CRSsNP), according to results of a phase 2 randomized trial published in the Journal of Allergy and Clinical Immunology.

The investigators noted that CRSsNP is a heterogeneous inflammatory disease affecting up to 8% of the population and that no biologic therapies are currently approved for the condition. They evaluated the efficacy and safety of dupilumab, a monoclonal antibody targeting the interleukin-4/interleukin-13 signaling pathway, and explored whether response differed by T2-inflammatory endotype.

In the 6-month, double-blind, placebo-controlled trial, 33 adults received dupilumab 300mg or placebo every 2 weeks. The primary outcomes were changes in 22-item Sino-Nasal Outcome Test (SNOT-22) and mini-Rhinoconjunctivitis Quality of Life Questionnaire (mini-RQLQ) scores. Dupilumab significantly improved SNOT-22 scores (−7.0 vs placebo; P < .001) and mini-RQLQ scores (−5.2 vs placebo; P < .01).

Reductions in CT sinus scores and rescue medication use, both secondary outcomes, favored dupilumab but were not statistically significant. In prespecified analyses of T2-high patients, defined by pronounced allergen skin test positivity or elevated blood eosinophils, improvement in SNOT-22 was numerically greater (−11.3; P = .07), and improvement in mini-RQLQ was significant (−9.2; P < .01). Treatment was well tolerated, and all participants completed the study, the authors reported.

The authors concluded that dupilumab was associated with meaningful improvements in patient-reported outcomes and that the trend toward greater benefit in T2-high patients supports the potential for endotype-directed therapy. They said larger studies are needed to evaluate the role of T2-targeted biologics in CRSsNP management.

Source: Tversky J, Lane AP, Schroeder J, et al. Efficacy of dupilumab for patients with chronic rhinosinusitis without nasal polyps: a randomized double-blind placebo controlled phase II study. J Allergy Clin Immunol. Published online October 9, 2026. PMID: 42854988. doi:10.1016/j.jaci.2026.08.032