Evolving trends in dupilumab use for chronic rhinosinusitis with nasal polyps (CRSwNP): a 4-year cohort analysis.

Chronic rhinosinusitis with nasal polyps (CRSwNP) affects up to 4.5% of the population and is frequently driven by type 2 inflammation. Dupilumab, targeting IL‑4 and IL‑13 pathways, was approved in 2019 as the first biologic for CRSwNP in Germany. This single-center, retrospective study analyzed 174 patients initiating dupilumab between 2019 and 2023. Patients were grouped by year and assessed for trends in demographics, surgical history, and treatment response. Only adherent patients with ≥ 6 months of follow-up were included. Age and baseline disease severity were stable across cohorts. However, the proportion of patients with > 3 prior sinus surgeries declined from 28.3% in 2019/20 to 13.0% in 2023, suggesting earlier biologic initiation over time. All patients met at least three EPOS 2020 criteria. Significant and clinically meaningful improvements were observed in all cohorts for Nasal Polyp Score (NPS), SNOT‑22, VAS, and olfactory testing, with changes exceeding established minimal clinically important differences (MCIDs). No cohort showed superior outcomes. Tese findings highlight consistent real-world efficacy of dupilumab and evolving prescribing patterns that favor earlier intervention, while reflecting continued cautious patient selection in the context of high treatment costs.