TOPLINE:

Dupilumab and tezepelumab yielded comparable benefits in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), with comparable reductions in nasal polyp and nasal congestion scores. In patients with comorbid asthma, dupilumab yielded greater improvements in symptom control.

METHODOLOGY:

• Researchers conducted an indirect treatment comparison (Bucher method) using placebo as a common comparator to evaluate the efficacy of dupilumab and tezepelumab in patients with CRSwNP.
• The analysis included participants from the LIBERTY NP SINUS-24 and SINUS-52 trials (N = 724; mean age, 52 years; 60% men) and the WAYPOINT trial (N = 408; mean age, 49.7 years; 65.2% men).
• The endoscopic outcome was assessed using the nasal polyp score, and symptom-based outcome was assessed using the nasal congestion score (higher scores indicated poorer outcomes).

TAKEAWAY:

• Dupilumab and tezepelumab showed comparable improvements across endoscopic and symptom-based outcomes in CRSwNP, with no significant differences in nasal polyp score (mean difference, 0.32; 95% CI, -0.17 to 0.81) or nasal congestion score (mean difference, -0.06; 95% CI, -0.31 to 0.19).
• Over 52 weeks, tezepelumab reduced the hazard of needing oral corticosteroids or surgery by 67% compared with dupilumab (hazard ratio, 0.33; 95% CI, 0.13-0.82), although the absolute rates of these events were similar with both drugs.
• In patients with comorbid asthma, dupilumab yielded greater reductions in Asthma Control Questionnaire scores than tezepelumab (mean difference, 0.43; 95% CI, 0.18-0.68).

IN PRACTICE:

"Direct comparative RCT's [randomized controlled trials] are needed to confirm the relative efficacy and safety of tezepelumab versus dupilumab in T2 [type 2] high UAD [unified airway disease] and also further review into the effects in T2 low patients. Furthermore, the exploration of combined biomarkers in CRSwNP such as BEC [blood eosinophil counts], FeNO [fractional exhaled nitric oxide] and IgE [immunoglobulin E] or nasal cytokine profiles may further optimize patient selection," the authors wrote.

SOURCE:

Philipp Suter, MD, with the University of Dundee, Dundee, Scotland, was the corresponding author of the study, which was published online on January 22 in Annals of Allergy, Asthma & Immunology. 

LIMITATIONS:

The efficacy of both drugs was evaluated at different time intervals. The lack of individual patient data prevented a matching‑adjusted indirect comparison and full adjustment for baseline differences. Placebo response rates varied, and unmeasured confounders, such as regional differences in care, could not be fully accounted for in this indirect analysis.

DISCLOSURES:

Several authors reported receiving speaker and lecture fees, travel reimbursement, research funding, and nonfinancial support, and serving as consultants or advisors to various pharmaceutical companies. One author disclosed that his son works for AstraZeneca, the developer of tezepelumab.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.