Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a disease that significantly affects the patient quality of life, it shares it pathogenic mechanism through type-2 inflammation with other diseases like, bronchial asthma and eczema. This disease is known to be more severe with higher recurrence rates comparing to other types of chronic rhinosinusitis.1 Patients with CRSwNP may require multiple surgeries along with medical management, and over the last couple of years this proportion of patients was offered the new biologic therapy “Dupilumab” which is very effective in controlling their disease.2 Dupilumab was approved by the Food and Drug Administration for treating CRSwNP. It is a monoclonal antibody that exerts its effect by blocking the activity of IL-4 and IL-13 which plays an important role in type-2 inflammation.3 Dupilumab was approved by the Food and Drug Administration for treating CRSwNP in 2019 and since then many studies has confirmed its effectiveness.2-6 It is delivered subcutaneously every two weeks for the first year, however following that there has been no agreement on the proper dose adjustment. This medication has been used in JHAH since the late 2020, and the protocol applied here was to shift the patient to once monthly injection after the first year. Objectives: To assess if the change in dosing after the first year has affected the effectiveness of Dupilumab Materials and Methods: The patients who have been receiving Dupilumab for more than a year and has been shifted to the once monthly regimen for at least four months will be included in the study. The following parameters will be used to assess CRSwNP control: Sino-Nasal Outcome Test (SNOT) score, serum IgE levels, absolute eosinophilic count, nasal polyp size and the Lund-Mackay score. These parameters will be compared at three points of time as follows: before starting the treatment, at least four months after starting Dupilumab and at least four months after adjusting the dose.

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