Impact of single versus multiple surgeries in CRSwNP patients undergoing treatment with dupilumab

Background: Prior to the introduction of biologic drugs, the natural history of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) was characterized by multiple recurrences, thus necessitating multiple surgical interventions. Aims/Objectives: To understand whether Dupilumab efficacy in recurrent CRSwNP varies based on number of previous surgeries. Materials and Methods: This is a multicentric retrospective study on patients with CRSwNP under Dupilumab, who underwent at least one previous surgery. Correlations between number of previous surgeries and clinical outcomes at baseline and during treatment were investigated. Results: 141 patients were included. Mean number of prior surgeries was 2.19 (median 2; range 1-13). For all patients, significant improvements were observed across all time points. Poorer results were observed in patients subjected to more than one prior surgery in terms of NPS at T2 (p.04), SNOT-22 at T4 (p.03), VAS for olfactory dysfunction at T3 (p.01) and T5 (p.009), VAS for nasal obstruction at T4 (p.047), VAS for rhinorrhea at T4 (p.02), VAS for craniofacial pain at T1 (p.02) and T2 (p.04) and of VAS for sleep disturbances at T1 (p.04). Conclusions and significance: Patients subjected to multiple surgeries have worse outcomes during treatment with Dupilumab, particularly for what concerns craniofacial pain and olfactory dysfunction.