Impact of prednisolone tapering and extended dupilumab dosing intervals on comorbid asthma in patients with chronic rhinosinusitis with nasal polyps.

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) frequently coexists with asthma and involves type 2 inflammation. Dupilumab enables prednisolone (PSL) tapering and extended dosing intervals in CRSwNP, but the impact on comorbid asthma is unclear.

OBJECTIVES

We evaluated the impact of PSL tapering and extended dupilumab dosing intervals on asthma outcomes in patients with CRSwNP.

METHODS

We retrospectively analyzed 60 patients with CRSwNP and comorbid asthma treated with dupilumab between 2020 and 2023 who reduced oral PSL to ≤1 mg within 1 year on dupilumab administered every 2 weeks and then extended the dosing interval to ≥3 weeks. Airway outcomes including nasal polyp score, CT score, olfactory function, asthma control test, spirometry, oscillometry, fractional exhaled nitric oxide, blood eosinophils, serum IgE, and annual exacerbation frequency were assessed at baseline, 3 months, and annually up to 3 years.

RESULTS

Nasal polyp score, CT score, asthma control test and fractional exhaled nitric oxide improved within 3 months and remained stable during PSL tapering and interval extension. Forced expiratory volume in 1 second and R5 improved transiently but gradually returned toward baseline over time. Eosinophil counts rose after PSL tapering but subsequently declined despite reduced dupilumab frequency. Total IgE and exacerbation frequency remained consistently suppressed. Subgroup analyses showed that asthma control improved or remained well controlled irrespective of baseline severity or step-down in asthma treatment.

CONCLUSIONS

In patients with CRSwNP and comorbid asthma, PSL tapering and extension of dupilumab dosing intervals were feasible and did not worsen asthma control when sinonasal disease remained well controlled.