Dual REmission in moderate-to-severe AsthMa and Nasal Polyps: a multicentric observational Phase IV real-life study (DREAM-NP)

Background: Achieving simultaneous ’dual remission’ in both upper and lower airways is the clinical goal for comorbid asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). This multicentric observational study evaluated the 24-month real-world effectiveness of dupilumab in reaching these stringent endpoints. Methods: A retrospective study of 205 adult patients was conducted. Remission was defined by SANI criteria for asthma and modified EPOS/EUFOREA-DUPIREAL benchmarks for CRSwNP. Complete recovery required dual remission plus normosmia restoration. Results: At 24 months, 77.4% of patients with severe asthma achieved CRSwNP remission, significantly higher than the 61.8% in the moderate asthma group (p = 0.0309). Dual remission was reached by 22.9% of the overall cohort. High baseline FeNO (≥50 ppb) was the strongest predictor for dual remission (34.5%) and normosmia restoration (19.2%). Prior surgery did not hinder long-term outcomes; surgical patients achieved complete recovery significantly faster at 12 months (16.7% vs. 3%, p = 0.0115). A higher surgical burden positively predicted olfactory restoration (OR = 4.0 per revision, p = 0.045). Conclusions: Dupilumab is highly effective over the long term, exhibiting a structural ’catch-up“ effect. While high baseline Type 2 biomarkers and surgical history are positive prognostic indicators, the persistent ”clinical-functional gap’ suggests earlier intervention is critical to prevent irreversible neuroepithelial damage. Clinical trial registration: www.clinicaltrials.gov identifier is NCT07574294.