Comparing Nucala®, Dupixent®, and Xolair® For The Treatment of Nasal Polyps
Nasal polyps can be a debilitating condition, affecting millions of people worldwide. Fortunately, with the advent of new treatments, such as Nucala®, Dupixent®, and Xolair®, relief is now available. These biologics target specific pathways in the immune system, providing hope for those suffering from this condition. However, with multiple treatment options available, it can be difficult to determine which biologic is the best choice. In this article, we will explore the pros and cons of each treatment, including their biologic targets and the frequency of administration, as well as summarize the results of studies on their effectiveness in treating nasal polyps.
Medically Reviewed By:
Dr Leslie Koh
M.B;B.S. (Singapore), MRCS (ENT) Edinburgh, M. Med (ORL), FAMS
If you are dealing with nasal polyps, you are likely seeking a treatment that can help alleviate your symptoms. While there are several options available, biologics have gained attention in recent years for their ability to target specific pathways that contribute to the development and persistence of nasal polyps. Three biologics that have shown promise in this area are Mepolizumab (Nucala), Dupilumab (Dupixent), and Omalizumab (Xolair), in no particular order. In this article, we will take a closer look at each of these drugs, to help you make an informed decision about which one may be right for you.
What are Nasal Polyps?
Before we dive into the specifics of these biologics, let’s first define what nasal polyps are.
Nasal polyps are soft, painless growths that develop in the lining of the nose or sinuses. They are often linked to chronic inflammation and can cause a range of symptoms, including congestion, runny nose, sneezing, decreased sense of smell, and facial pain or pressure.
Nasal polyps are typically treated with medications, such as steroids, but in some cases, endoscopic sinus surgery may be necessary.
What Is Mepolizumab (Nucala®)?
Mepolizumab is a biologic medication that targets interleukin-5 (IL-5), a protein that is involved in the growth and survival of eosinophils, a type of white blood cell that is commonly found in nasal polyps. By blocking IL-5, Mepolizumab can reduce the number of eosinophils and alleviate the associated inflammation.
How is Mepolizumab administered?
Mepolizumab is administered via injection under the skin once every 4 weeks.
What are the potential side effects of Mepolizumab?
Common side effects of Mepolizumab include headache, injection site reactions, back pain, and fatigue. More serious side effects, such as allergic reactions, are rare but possible.
How effective is Mepolizumab for treating nasal polyps?
Studies have shown that Mepolizumab can reduce the size of nasal polyps and improve symptoms in people with severe nasal polyps. One study found that 53% of people who received Mepolizumab had at least a 50% reduction in their nasal polyp score, compared to only 19% of people who received a placebo.
The dosage may vary depending on the patient’s age, weight, and medical condition. Patients should not exceed the recommended dose or take the medication for longer than prescribed.
What Is Dupilumab (Dupixent®)?
Dupilumab is a biologic medication that targets interleukin-4 (IL-4) and interleukin-13 (IL-13), two proteins that play a role in the inflammation associated with nasal polyps. By blocking these proteins, Dupilumab can reduce inflammation and improve symptoms.
How is Dupilumab administered?
Dupilumab is administered via injection under the skin every 2 weeks.
What are the potential side effects of Dupilumab?
Common side effects of Dupilumab include injection site reactions, eye and eyelid inflammation, and cold sores. More serious side effects, such as allergic reactions, are rare but possible.
How effective is Dupilumab for treating nasal polyps?
Studies have shown that Dupilumab can reduce the size of nasal polyps and improve symptoms in people with severe nasal polyps. One study found that 71% of people who received Dupilumab had at least a 50% reduction in their nasal polyp score, compared to only 13% of people who received a placebo.
The dosage may vary depending on the patient’s age, weight, and medical condition. Patients should not exceed the recommended dose or take the medication for longer than prescribed.
What Is Omalizumab (Xolair®)?
Omalizumab is a biologic medication that targets immunoglobulin E (IgE), a type of antibody that plays a role in the allergic response that can contribute to nasal polyps. By binding to IgE, Omalizumab can prevent it from triggering an allergic response and reduce inflammation.
How is Omalizumab administered?
Omalizumab is administered via injection under the skin every 2 to 4 weeks, depending on the dose.
What are the potential side effects of Omalizumab?
Common side effects of Omalizumab include injection site reactions, headache, and upper respiratory tract infections. More serious side effects, such as anaphylaxis, are rare but possible.
How effective is Omalizumab for treating nasal polyps?
Studies have shown that Omalizumab can reduce the size of nasal polyps and improve symptoms in people with severe nasal polyps. One study found that 52% of people who received Omalizumab had at least a 50% reduction in their nasal polyp score, compared to only 16% of people who received a placebo.
Comparing Mepolizumab, Dupilumab, and Omalizumab
All three of these biologics have been shown to be effective in reducing the size of nasal polyps and improving symptoms in people with severe nasal polyps. However, there are some differences between them that may influence your decision.
Administration
Mepolizumab is administered once every 4 weeks, while Dupilumab and Omalizumab are administered every 2 weeks. Depending on your preference and schedule, one of these options may be more convenient for you.
Targeted Proteins
Mepolizumab targets IL-5, Dupilumab targets IL-4 and IL-13, and Omalizumab targets IgE. While all of these proteins play a role in the inflammation associated with nasal polyps, they do so through different mechanisms. Depending on the underlying cause of your nasal polyps, one of these biologics may be more effective for you.
Side Effects
All three of these biologics have potential side effects, but the specific side effects may vary. Common side effects of Mepolizumab include headache and injection site reactions, while common side effects of Dupilumab include eye and eyelid inflammation and cold sores. Common side effects of Omalizumab include headache and upper respiratory tract infections. You should discuss the potential side effects with your doctor to determine which biologic may be the best option for you.
| Biologic | Pros | Cons | Frequency of Administration | Effectiveness on Nasal Polyps |
|---|---|---|---|---|
| Mepolizumab (Nucala) |
|
| Every 4 weeks | Shown to be effective in several clinical trials, including POLYP 1 and POLYP 2 |
| Dupilumab (Dupixent) |
|
| Every 2 weeks for first 3 doses, then every 4 weeks | Shown to be effective in several clinical trials, including LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52 |
| Omalizumab (Xolair) |
|
| Every 2 or 4 weeks, depending on dose | Shown to be effective in several clinical trials, including POLYP 1 and POLYP 2 |
Are Biologics Suitable For All Patients With Nasal Polyps?
The criteria for starting biologics for nasal polyps typically include having a diagnosis of chronic rhinosinusitis with nasal polyps, and experiencing persistent symptoms despite the use of other treatments, such as nasal steroid sprays or oral corticosteroids. Some patients may or may not have had sinus surgery. Additionally, a person’s medical history and current medications may be considered when determining if biologics are an appropriate treatment option. It is important to discuss your symptoms and medical history with your doctor to determine if starting biologics for nasal polyps is right for you; your doctor will also be able to provide guidance on which biologic may be the most appropriate for your individual case.
What Are The Specific Criteria For Starting Treatment With Mepolizumab / Dupilumab / Omalizumab For Nasal Polyps?
While the specific criteria for starting treatment with Mepolizumab, Dupilumab, and Omalizumab may vary, there are some general similarities and differences that can be compared and contrasted.
Mepolizumab is typically indicated for individuals with severe eosinophilic asthma and/or chronic rhinosinusitis with nasal polyps who have elevated eosinophil levels in their blood or nasal tissue. This biologic works by targeting and blocking a protein called interleukin-5 (IL-5), which plays a role in the formation and maintenance of eosinophils. Therefore, individuals who have high levels of eosinophils are more likely to benefit from treatment with Mepolizumab.
Dupilumab, on the other hand, is indicated for individuals with moderate-to-severe atopic dermatitis, as well as those with moderate-to-severe asthma and/or chronic rhinosinusitis with nasal polyps. This biologic works by blocking the signaling of two proteins called interleukin-4 (IL-4) and interleukin-13 (IL-13), which are involved in the inflammation and allergic response that can contribute to the development of nasal polyps.
Omalizumab is indicated for individuals with moderate-to-severe asthma who have allergies that are not controlled by inhaled corticosteroids, as well as those with chronic urticaria. This biologic works by targeting and blocking a protein called immunoglobulin E (IgE), which is involved in the allergic response. While Omalizumab is not specifically indicated for the treatment of nasal polyps, some studies have shown that it may be effective in reducing polyp size and improving symptoms in certain individuals.
In summary, while all three biologics may be used for the treatment of chronic rhinosinusitis with nasal polyps, they have different indications and mechanisms of action. Mepolizumab targets and blocks IL-5, making it particularly effective in individuals with high eosinophil levels. Dupilumab blocks the signaling of IL-4 and IL-13, which can contribute to the development of nasal polyps. Omalizumab targets and blocks IgE, which is involved in the allergic response. The specific criteria for starting treatment with each biologic may vary based on individual factors such as medical history, current medications, and symptom severity.
How Is A Decision Made Regarding Which Biologic To Use For Nasal Polyps?
When making a decision on which biologic to use for the treatment of nasal polyps, several factors are taken into consideration. Nasal polyps are often associated with chronic rhinosinusitis with nasal polyps (CRSwNP), which is a chronic inflammatory condition of the nasal and sinus lining. The inflammation is often driven by a type of immune cell called eosinophils, which release pro-inflammatory proteins that contribute to the development and growth of polyps.
One of the main factors considered when selecting a biologic for CRSwNP is the individual’s biomarker profile. Biomarkers are measurable indicators of the underlying disease process and may include blood or nasal tissue tests to assess the levels of certain proteins or immune cells. For example, individuals with high levels of eosinophils may benefit from biologics that target and block the protein IL-5, such as Mepolizumab. This biologic has been shown to reduce the frequency and severity of nasal polyps in individuals with high eosinophil levels.
Another factor that may influence the decision on which biologic to use is the individual’s medical history and other comorbid conditions. For instance, individuals with moderate-to-severe atopic dermatitis or a history of allergic rhinitis may benefit from Dupilumab, which blocks the signaling of interleukin-4 (IL-4) and interleukin-13 (IL-13). These cytokines play a key role in the development of atopic diseases, including allergic rhinitis and atopic dermatitis.
Omalizumab, which blocks immunoglobulin E (IgE), may be preferred for individuals with a history of allergies that are not controlled by inhaled corticosteroids. This biologic has been shown to improve symptoms of allergic asthma and chronic idiopathic urticaria, as well as nasal symptoms in individuals with CRSwNP.
Other factors that may be considered when selecting a biologic include the individual’s insurance coverage, cost, and potential side effects. Some biologics may be more expensive than others, and insurance coverage may vary depending on the specific biologic and the individual’s insurance plan.
Additionally, potential side effects of each biologic should be discussed, such as injection site reactions, allergic reactions, and the risk of infections.
In conclusion, when making a decision on which biologic to use for the treatment of nasal polyps, healthcare providers consider several factors, including the individual’s biomarker profile, medical history, and potential side effects. A collaborative decision-making approach should be taken, involving the individual and their healthcare provider, to determine the most appropriate course of treatment for each individual
How Long Do I Need To Use These Biologics For?
The length of treatment with these biologics varies depending on the individual’s response to the medication and the severity of their nasal polyps. In clinical trials, treatment with these biologics has ranged from 16 to 52 weeks. However, some individuals may require longer-term treatment to maintain symptom improvement. It is important to discuss the duration of treatment with your doctor to determine the best course of action for your specific case. Additionally, regular follow-up appointments with your doctor will help ensure that your treatment plan is working effectively and that any necessary adjustments can be made.
Conclusion
Mepolizumab (Nucala), Dupilumab (Dupixent), and Omalizumab (Xolair) are all biologics that have shown promise in reducing the size of nasal polyps and improving associated symptoms. Each of these drugs targets different proteins and has its own unique administration and potential side effects. Discussing these options with your doctor can help you make an informed decision about which biologic may be the most effective and appropriate for you.
Frequently Asked Questions
References:
Gevaert P, Lang-Loidolt D, Lackner A, et al. Nasal IL-5 levels determine the response to anti-IL-5 treatment in patients with nasal polyps. J Allergy Clin Immunol. 2006;118(5):1133-1141. doi:10.1016/j.jaci.2006.06.010
Bachert C, Mannent L, Naclerio RM, et al. Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis: A Randomized Clinical Trial. JAMA. 2016;315(5):469-479. doi:10.1001/jama.2015.19330
Bachert C, Sousa AR, Lund VJ, et al. Reduced need for surgery in severe nasal polyposis with mepolizumab: Randomized trial. J Allergy Clin Immunol. 2017;140(4):1024-1031.e14. doi:10.1016/j.jaci.2017.05.010
Han JK, Bachert C, Fokkens WJ, et al. Mepolizumab improves quality of life and asthma control in patients with severe eosinophilic asthma and nasal polyps. J Allergy Clin Immunol Pract. 2020;8(6):2060-2071.e11. doi:10.1016/j.jaip.2020.03.044
Wang X, Zhang N, Bo M, Holtappels G, Zheng M, Lou H. Effect of omalizumab in inadequately controlled Chinese patients with nasal polyps and asthma: a randomized controlled trial. Int Forum Allergy Rhinol. 2019;9(12):1479-1487. doi:10.1002/alr.22415
Disclaimer:
The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition, treatment or medication and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website. If you think you may have a medical emergency, call 995 or visit the nearest Emergency Department immediately. No doctor-patient relationship is created by this website or its use. Neither the owner of the website, nor its employees, or any contributor to this web site, makes any representations, express or implied, with respect to the information provided herein or to its use.
