Dual REmission in moderate-to-severe AsthMa and nasal polyps: a multicentric observational phase IV real-life study (DREAM-NP)

Background Achieving simultaneous ’dual remission’ in both upper and lower airways is the clinical goal for comorbid asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). This multicentric observational study evaluated the 24-month real-world effectiveness of dupilumab in reaching these stringent endpoints.Methods A retrospective study of 205 adult patients was conducted. Remission was defined by SANI criteria for asthma and modified EPOS/EUFOREA-DUPIREAL benchmarks for CRSwNP. Complete recovery required dual remission plus normosmia restoration.Results At 24 months, 77.4% of patients with severe asthma achieved CRSwNP remission, significantly higher than the 61.8% in the moderate asthma group (p = 0.0309). Dual remission was reached by 22.9% of the overall cohort. High baseline FeNO (≥50 ppb) was the strongest predictor for dual remission (34.5%) and normosmia restoration (19.2%). Prior surgery did not hinder long-term outcomes; surgical patients achieved complete recovery significantly faster at 12 months (16.7% vs. 3%, p = 0.0115). A higher surgical burden positively predicted olfactory restoration (OR =4.0 per revision, p = 0.045).Conclusions Dupilumab is highly effective over the long term, exhibiting a structural ’catch-up“ effect. While high baseline Type 2 biomarkers and surgical history are positive prognostic indicators, the persistent ”clinical-functional gap’ suggests earlier intervention is critical to prevent irreversible neuroepithelial damage.Clinical trial registration www.clinicaltrials.gov identifier is NCT07574294.

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Journal
Expert Opinion on Biological Therapy
Published
2026-07-24
DOI
https://doi.org/10.1080/14712598.2026.2710254
Primary Topic
Sinusitis and nasal conditions
Type
article
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article

Dual REmission in moderate-to-severe AsthMa and nasal polyps: a multicentric observational phase IV real-life study (DREAM-NP)

Paolo Cameli, Giancarlo Ottaviano, Alessio De Massimi, Rory Chan et al.
Expert Opinion on Biological Therapy
Sinusitis and nasal conditions
article

Dual REmission in moderate-to-severe AsthMa and nasal polyps: a multicentric observational phase IV real-life study (DREAM-NP)

Paolo Cameli, Giancarlo Ottaviano, Alessio De Massimi, Rory Chan, Alvise Berti, Antonio Romano, Gianenrico Senna, Eugenio De Corso, Marcello Cottini, Angelo Ghidini, Umberto Semenzato, L Corsi, Fabio Giuseppe Vassallo, Walter Cestaro, Riccardo Pozzan, Francesco Menzella, F Gialdini, Laura Ventura, Michela Bortoli, Tatiana Scandiuzzi Piovesan, Sara Munari, Marco Caminati, Carlo Lombardi, Paolo Russo, Andrea Tozzi, Claudia Rinaldo, Maria Rita Marchi, Isabella Ruzzon
article en

Abstract

Background Achieving simultaneous ’dual remission’ in both upper and lower airways is the clinical goal for comorbid asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). This multicentric observational study evaluated the 24-month real-world effectiveness of dupilumab in reaching these stringent endpoints.Methods A retrospective study of 205 adult patients was conducted. Remission was defined by SANI criteria for asthma and modified EPOS/EUFOREA-DUPIREAL benchmarks for CRSwNP. Complete recovery required dual remission plus normosmia restoration.Results At 24 months, 77.4% of patients with severe asthma achieved CRSwNP remission, significantly higher than the 61.8% in the moderate asthma group (p = 0.0309). Dual remission was reached by 22.9% of the overall cohort. High baseline FeNO (≥50 ppb) was the strongest predictor for dual remission (34.5%) and normosmia restoration (19.2%). Prior surgery did not hinder long-term outcomes; surgical patients achieved complete recovery significantly faster at 12 months (16.7% vs. 3%, p = 0.0115). A higher surgical burden positively predicted olfactory restoration (OR =4.0 per revision, p = 0.045).Conclusions Dupilumab is highly effective over the long term, exhibiting a structural ’catch-up“ effect. While high baseline Type 2 biomarkers and surgical history are positive prognostic indicators, the persistent ”clinical-functional gap’ suggests earlier intervention is critical to prevent irreversible neuroepithelial damage.Clinical trial registration www.clinicaltrials.gov identifier is NCT07574294.

Expert Opinion on Biological Therapy
University of Siena (IT), University of Verona (IT), University of Padua (IT), University of Dundee (GB), University of Trento (IT), University of Perugia (IT), Ospedale Santa Chiara (IT), Ito Hospital (JP), Regional Health (US), Sina Hospital (IR), Azienda Ospedaliera Santa Maria Degli Angeli (IT), Ospedale Santa Maria (IT), Fondazione Poliambulanza Istituto Ospedaliero (IT)
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Sinusitis and nasal conditions
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