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

## TL;DR

This study shows that reducing prednisolone and extending dupilumab dosing intervals in patients with nasal polyps and asthma does not worsen asthma control.

## Contribution

The study provides evidence that dupilumab dosing intervals can be extended without worsening asthma in patients with comorbid CRSwNP.

## Key findings

- Asthma control test and fractional exhaled nitric oxide improved and remained stable during treatment adjustments.
- Eosinophil counts initially rose after prednisolone tapering but later declined despite less frequent dupilumab.
- Total IgE and asthma exacerbation frequency remained suppressed throughout the study period.

## Abstract

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.

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

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.

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.

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.