A new medication is providing relief for individuals suffering from chronic rhinosinusitis with nasal polyps (CRSwNP), a condition that can severely impact quality of life by causing persistent nasal blockage, loss of smell and taste, and sleep disturbances. The drug, dupilumab, received approval from the National Institute for Health and Care Excellence (NICE) in February for use on the National Health Service (NHS).
CRSwNP is an inflammatory disease characterized by long-term swelling in the nasal passages and sinuses, often leading to the development of non-cancerous growths called nasal polyps. These polyps can grow large enough to cause significant breathing difficulties and facial pain. While steroid sprays and surgery are common treatments, they often provide only temporary relief, and polyps can return. According to a 2022 study in Respiratory Medicine, nearly half of patients experience recurring symptoms within a year of surgery.
Cath Ross, 59, experienced symptoms of CRSwNP for two decades, struggling with severe nasal congestion that disrupted her sleep and work. Her condition also led to a complete loss of smell and taste, diminishing her enjoyment of food and daily life. Traditional treatments, including steroid sprays and surgery in 2007, offered only short-term improvement, with her symptoms returning within a year.
"Having this condition is effectively like having a bad cold, feeling bunged up but without feeling unwell, so is very debilitating," said Matthew Trotter, a consultant ear, nose and throat surgeon. "Often it causes pain in the face and forehead... The pain is from a large volume of polyps, which can grow to the size of a large grape."
Dupilumab, administered via an injector pen every two weeks, works by targeting specific inflammatory proteins called cytokines. Unlike oral steroids, which can have side effects such as high blood pressure and diabetes, this monoclonal antibody treatment has fewer systemic side effects, though it can cause muscle aches or dry, itchy eyes.
Cath participated in clinical trials for dupilumab and, after further unsuccessful surgery, was granted access to the drug by its manufacturer, Sanofi, in 2022. She reported a significant improvement within two weeks of starting treatment, with her sense of smell and taste returning. "Two weeks after starting on dupilumab, my smell and taste came back," Cath stated. "The first time I realised that was when I was filling up my car and the smell of the petrol was very powerful."
To qualify for dupilumab, patients must have had the condition for at least 12 weeks, failed to respond to steroid treatments, and either undergone surgery or demonstrated a severe impact on their lives. The drug is already used for some asthma and eczema patients.
"All the evidence so far suggests that in the right patient – in other words, those with all the typical symptoms such as a constant congested nose – dupilumab is a superb adjunct to those who may have had lots of nasal surgery in the past because their polyps grow back," Trotter added. "We believe we’ve now got something that will actually modify this disease to stop symptoms and multiple surgeries."
Professor Carl Philpott of the University of East Anglia noted that the development of new drugs for CRSwNP is ongoing, with other treatments like tezepelumab also showing promise. As more options become available, costs are expected to decrease, improving accessibility on the NHS. For patients like Cath, the new treatment represents a significant improvement in their daily lives, allowing them to reconnect with sensory experiences they had lost. "Since being on this drug, I’ve got my life back," Cath said. "I’m more social again and enjoy holidays."