In recent years, it is being increasingly recognised that chronic rhinosinusitis with nasal polyps (CRSwP) is a type 2 chronic inflammation based on IL-4 and IL-13, and the novel monoclonal antibody, such as dupilumab, is likely to have a major role in the control of this disease in comparison with surgery, such as FESS. This is a review article in which authors have scrutinised six publications from thousands of articles considered. The outcomes are based on quality-of-life years, SNOT-22 score, smell identification scores and cost effectiveness of different treatment modalities. The following deductions were made. The nasal polyp scores were significantly better in the FESS group. The improvement in SNOT-22 scores was comparable in both treatment modalities, as per one study but interestingly, the psychological domain of SNOT-22 was better in the FESS group. In patients treated with dupilumab, better improvement occurred in the extra-nasal rhinological domain with better olfaction scores. The results on quality-of-life years (QALY) scores were contradictory in two studies. However, dupilumab seemed to improve symptoms of asthma and atopic dermatitis. FESS treatment, as expected, was far more cost effective compared to the cost of dupilumab which, at present, is fivefold. It is expected that after the 10-year patent period of dupilumab is over, the costs of the two modalities of treatment may be comparable. This is an interesting read. It shows that FESS treatment still proves highly comparable to dupilumab and, thus, it puts both treatment modalities in their right perspectives.
A comparison between biologic and surgical treatment (FESS) for chronic rhinosinusitis with polyposis
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