Dupilumab, an IL-4Rα antagonist blocking both IL-4 and IL-13 signalling, is approved for refractory CRSwNP. Which of the following represents the ideal candidate for biologic therapy in CRSwNP according to current guidelines?

• A First-line treatment for all CRSwNP regardless of prior surgery or medical therapy
• B CRSwNP with anosmia as the sole symptom, without eosinophilia
• C CRSwNP post-FESS in remission as maintenance monotherapy
• D Severe bilateral CRSwNP refractory to nasal corticosteroids, prior FESS, and systemic steroids, with comorbid asthma or elevated eosinophils ✓

Explanation

Biologics (dupilumab, mepolizumab, omalizumab) are indicated as add-on therapy for severe bilateral CRSwNP that is inadequately controlled despite maximal medical management (intranasal corticosteroids, saline irrigation) and prior appropriate surgery (FESS), particularly in patients with co-existing eosinophilic asthma, elevated blood eosinophils (≥150 cells/μL), or AERD. They are not first-line agents and not indicated for mild-moderate disease or single-symptom presentations without the Type 2 endotype signature.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.