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:
the condition is not controlled well enough by systemic corticosteroids or sinus surgery, and
they have had at least 1 sinus surgery, and
the 22-item sinonasal outcomes test (SNOT-22) score is at least 50, and
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.
Dupilumab must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. Dupilumab must be funded in England within 90 days of final publication of this guidance.
There is enough evidence to show that dupilumab provides benefits and value for money, so it can be used routinely across the NHS in this population.
NICE has produced tools and resources to support the implementation of this guidance.
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.