Does Prior Sinus Surgery Influence Dupilumab Treatment Response in CRSwNP?

Objectives.: To investigate whether prior endoscopic sinus surgery (ESS) influences long-term treatment response to Dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), including patient-reported outcomes, nasal polyp score and olfactory function. Methods.: This retrospective, single-centre real-world study included adult CRSwNP patients treated with Dupilumab between 2019 and 2025. Patient-reported outcome measures (PROMs) to assess symptom burden (i.e., SNOT-22, TNSS, ACT, PHQ-2, EQ-5D-3L), nasal polyp score (NPS) and olfactory performance were recorded longitudinally. Linear and piecewise linear mixed-effects models were used to analyse trajectories over time and compare outcomes by surgical status. Results.: A total of 224 patients were followed for up to 4.5 years, including 146 patients who had previously undergone ESS. Surgery-naïve patients had higher baseline disease burden across all outcomes. Dupilumab led to significant improvements in 6 all groups. Except for PHQ-2, which improved significantly faster in surgery-naïve patients during the early treatment phase (=0.310.14, p-value=0.03), trajectories were comparable. No significant differences were observed according to the number of previous surgeries or N-ERD status. Conclusion.: Dupilumab provides rapid and sustained clinical benefit in CRSwNP, independent of prior sinus surgery status. However, it should be noted that the influence of surgical extent could not be assessed in this cohort.