NICE (UK) positive for Dupixent (dupilumab) for treating severe chronic rhinosinusitis with nasal polyps – Sanofi

NICE(UK): Dupilumab, as an add-on to intranasal corticosteroids, can be used as an option to treat severe chronic rhinosinusitis with nasal polyps in adults if: i) the condition is not controlled well enough by systemic corticosteroids or sinus surgery, and ii) they have had at least 1 sinus surgery, and iii) the 22-item sinonasal outcomes test (SNOT-22) score is at least 50, and iv) the company provides it according to the commercial arrangement. This recommendation is not intended to affect treatment with dupilumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.

Why the committee made these recommendations: Usual treatment for severe chronic rhinosinusitis with nasal polyps that is not controlled well enough by systemic corticosteroids or sinus surgery, or both, includes further corticosteroids (intranasal and systemic) and further sinus surgery. For this evaluation, the company asked for dupilumab to be considered only for a subgroup of people who have had at least 1 sinus surgery and who have a SNOT-22 score of at least 50. This does not include everyone who it is licensed for.Clinical trial evidence suggests that dupilumab plus usual treatment reduces symptoms and nasal polyp size compared with placebo plus usual treatment in this subgroup. But there are uncertainties because the trials were not designed to specifically collect evidence for a subgroup with a SNOT-22 score of at least 50. But, even with the uncertainties, the most likely cost-effectiveness estimates are within the range that NICE considers a cost-effective use of NHS resources. So, dupilumab can be used.