Impact of dupilumab on SNOT-22 domain and individual item scores in chronic rhinosinusitis with nasal polyps

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease that significantly impairs quality of life. Dupilumab, a monoclonal antibody targeting IL-4 and IL-13 signaling, has emerged as a highly effective therapy for patients with severe, uncontrolled CRSwNP. This retrospective real-life cohort study assessed the impact of dupilumab on symptom severity using both subdomain and individual item scores of the validated Sino-Nasal Outcome Test-22 (SNOT-22). Eighty-nine patients with CRSwNP were evaluated before and after six months of dupilumab treatment. Significant and clinically meaningful improvements were observed in all four SNOT-22 domains-nasal, otologic/facial pain, sleep, and emotional-with the most pronounced reduction in nasal symptoms. Item-level analysis revealed the greatest improvements in decreased sense of smell/taste, nasal congestion, thick nasal discharge, post-nasal drip, and the need to blow the nose-symptoms also rated most severe at baseline. These findings underscore dupilumab's effectiveness in alleviating the most burdensome aspects of CRSwNP. Domain- and item-level SNOT-22 assessment may offer a clearer view of disease burden and treatment impact than the total score alone.