Dupilumab Versus Mepolizumab for Chronic Rhinosinusitis With Nasal Polyposis: An Indirect Treatment Comparison
Claire Hopkins, Joseph K. Han, Wytske J. Fokkens, Martin Wagenmann, Patricia Guyot, Asif Khan, Scott D. Nash, Zhixiao Wang, Yingxin Xu, Jérôme Msihid, Binod Neupane, Arpita Nag, Claus Bachert
Abstract
BACKGROUND: Dupilumab and mepolizumab have shown efficacy and safety in treating chronic rhinosinusitis with nasal polyps (CRSwNP). OBJECTIVE: Without available results from head-to-head randomized control trials (RCTs) comparing dupilumab with other biologics, we conducted an indirect treatment comparison (ITC) with mepolizumab. METHODS: A systematic literature review identified RCTs of biologics in CRSwNP. A Bucher ITC was performed, including nasal polyp score (NPS; range 0-8), nasal congestion (NC; 0-3), loss of smell (LOS; 0-3), University of Pennsylvania Smell Identification Test (UPSIT; 0-40), visual analog score (VAS; 0-10), Sino-Nasal Outcome Test (SNOT-22; 0-110), systemic corticosteroid (SCS) use or surgery for nasal polyps (NPs), and binary responder analyses for NPS and SNOT-22 improvement by ≥1/≥2 and ≥8.9, respectively. Matching-adjusted indirect comparisons (MAICs) were conducted as supporting analyses. RESULTS: SINUS-24/-52 (SYNAPSE-like subpopulation only) and SYNAPSE were identified for ITC. At 24 weeks, the change from baseline in NPS and the proportion of patients with a binary responder outcome of NPS improvement ≥1 were significantly (P < .05) greater in those receiving dupilumab than those receiving mepolizumab. At 52 weeks, improvements in NPS, NC, LOS, UPSIT, and VAS were significantly (P < .05) greater for dupilumab than mepolizumab. The proportion of patients achieving binary responder outcomes of NPS and SNOT-22 improvement by ≥1/≥2 and ≥8.9, respectively, was significantly (P < .05) higher, whereas SCS use was significantly (P < .05) reduced, for dupilumab versus mepolizumab. Surgery rate was numerically reduced with dupilumab versus mepolizumab. The MAIC analyses confirmed these results. CONCLUSION: Dupilumab was associated with greater improvements in CRSwNP-related outcomes versus mepolizumab.