A 45-year-old immunocompetent patient with chronic rhinosinusitis with nasal polyps (CRSwNP) has failed 3 months of topical corticosteroids and two courses of oral steroids. What biological agent is approved as add-on therapy for severe uncontrolled CRSwNP based on its mechanism of inhibiting IL-4 and IL-13 signaling?

• A Dupilumab (anti-IL-4Rα) ✓
• B Mepolizumab (anti-IL-5)
• C Omalizumab (anti-IgE)
• D Benralizumab (anti-IL-5Rα)

Explanation

Dupilumab is a human monoclonal antibody that targets the shared IL-4 receptor alpha (IL-4Rα) subunit, thereby blocking signaling of both IL-4 and IL-13 — the key type 2 inflammatory cytokines that drive eosinophilic airway inflammation and polyp formation in CRSwNP. It is approved specifically for severe uncontrolled CRSwNP and has shown significant reduction in polyp size, symptom scores, and the need for surgery. Mepolizumab and benralizumab target the IL-5 pathway, while omalizumab targets IgE and has a secondary indication in CRSwNP but with a different mechanism.

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.