The Utility of Intranasal Corticosteroids in Association With Dupilumab for Chronic Rhinosinusitis With Nasal Polyposis: A Real‐Life Multicenter Study by a Tuscany Group

ABSTRACT Objective Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition often associated with other type‐2 diseases. Dupilumab, a monoclonal antibody targeting IL‐4Rα, has revolutionized the treatment of severe CRSwNP. Traditionally, intranasal corticosteroids (INCS) are used in association with Dupilumab, but their necessity remains uncertain. Methods This real‐life, multicentric observational study was conducted across seven centers in Tuscany, Italy, involving 123 patients with severe, uncontrolled type‐2 CRSwNP treated with Dupilumab (300 mg/2 weeks) from January 2021 to December 2022. Parameters assessed included Sinonasal Outcome Test‐22 (SNOT‐22), Nasal Polyps Score (NPS), Sniffin' Sticks identification test (SSIT‐16), and Lund‐Mackay scores (LMS), along with blood eosinophil counts and adherence to INCS. Statistical analyses were performed to compare outcomes between INCS adherent and non‐adherent groups. Results A total of 123 patients, 53 men and 70 women with a mean age of 56.6 years were included. Significant improvements were observed in SNOT‐22, NPS, SSIT, and LMS over 12 months. INCS adherence was incomplete in 23.8% of patients. Initially, non‐adherent patients demonstrated a faster SNOT‐22 reduction, while adherent patients showed better NPS and SSIT improvements early on. By 12 months, differences between groups were not statistically significant. No demographic or clinical factors predicted INCS adherence. Conclusion Dupilumab is effective in managing type‐2 CRSwNP, potentially without INCS. While INCS may hasten initial improvements, long‐term outcomes are comparable with or without their use. Future randomized controlled trials are necessary to further clarify INCS's role in combination with Dupilumab.