Dupilumab Extended Interval Dosing in Chronic Rhinosinusitis With Nasal Polyps: A Systematic Review and Meta-analysis.

Abstract

To evaluate whether extending the dupilumab dosing interval beyond the standard every-two-weeks (Q2W) regimen maintains clinical, radiologic, and biomarker control in adults with chronic rhinosinusitis with nasal polyps (CRSwNP). PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched using predefined terms related to CRSwNP and dupilumab, with the final search in September 2025. Reference lists of included studies were also screened. Eligible studies enrolled adults with CRSwNP who transitioned from dupilumab 300 mg Q2W to extended intervals (≥Q4W). Two reviewers independently screened, extracted data, and assessed risk of bias using RoB2 and NIH tools. Random-effects meta-analyses synthesized sinonasal, radiologic, and biomarker outcomes. Subgroup analysis also compared switching after 6 versus 12 months of standard-dosing induction period. Nineteen studies met the inclusion criteria, and nine contributed to quantitative synthesis. Across 1075 patients, extended interval dosing preserved disease control. Pooled mean differences (Q4W vs Q2W) showed non-significant changes in 22-item Sinonasal Outcome Test (SNOT-22) (-0.56), nasal congestion (-0.73), olfaction (+0.23), nasal polyp score (-0.29), and Lund-Mackay score (-1.25). Eosinophils decreased significantly (-0.13 × 10⁹/L; P = .047). Subgroup analysis revealed a non-significant difference in clinical outcomes of Q4W dosing when comparing the 12- and 6-month induction protocols. Real-world studies showed the feasibility of further extension (Q6W-Q12W) in selected patients. Dupilumab interval extension to Q4W maintains clinical stability after 6 to 12 months of standard dosing, with potential for longer intervals in selected patients. Further controlled trials are required to define optimal tapering strategies and identify predictors of successful dose spacing.