Bucher indirect treatment comparison of phase 3 trials with dupilumab and tezepelumab in chronic rhinosinusitis with nasal polyps

BACKGROUND: Biologic therapies significantly affect clinical outcomes in patients with chronic rhinosinusitis with nasal polyps (CRSwNPs), including those with comorbid asthma. Tezepelumab and dupilumab act on upstream and downstream type 2 cytokine pathways, respectively. OBJECTIVE: To indirectly compare the relative efficacy of dupilumab with tezepelumab based on phase 3 randomized controlled trials in CRSwNP, including those with comorbid asthma. METHODS: A Bucher indirect head-to-head comparison of studies evaluating dupilumab and tezepelumab for relevant outcomes was performed. RESULTS: Dupilumab and tezepelumab demonstrated comparable significant improvements in endoscopic-, radiologic-, olfactory-, and symptom-based outcomes in CRSwNP. Relative differences in hazard ratios for use of oral corticosteroids and/or surgery favored tezepelumab. However, no differences were observed when considering absolute values. Dupilumab demonstrated superiority in patients with comorbid asthma for symptom control. CONCLUSION: Indirect treatment comparison revealed comparable overall clinical benefits of dupilumab and tezepelumab in CRSwNP. However, a prospective head-to-head randomized controlled trial would be needed to confirm their relative efficacy.