A 45-year-old immunocompetent patient with chronic rhinosinusitis with nasal polyps (CRSwNP) fails maximal medical therapy including systemic steroids and two FESS procedures. Biopsy confirms type 2 inflammatory pattern with eosinophilia. The most appropriate next biological therapy is:
- A Dupilumab (anti-IL-4Rα, blocking IL-4 and IL-13 signaling) ✓
- B Mepolizumab (anti-IL-5)
- C Omalizumab (anti-IgE) only if concomitant allergic asthma
- D Benralizumab (anti-IL-5Rα)
Correct answer: A. Dupilumab (anti-IL-4Rα, blocking IL-4 and IL-13 signaling)
Explanation
Dupilumab (anti-IL-4 receptor alpha monoclonal antibody) blocks both IL-4 and IL-13 signalling, which are central cytokines in type 2 inflammation driving eosinophilic CRSwNP. It is FDA-approved and has the strongest evidence for CRSwNP, significantly reducing polyp size, improving nasal symptoms, and reducing need for surgery. Mepolizumab and benralizumab target IL-5 pathway and have some evidence but dupilumab is the most validated. Omalizumab is approved for CRSwNP but targets IgE rather than the core type 2 pathway.
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.