Dupilumab Versus Omalizumab: Greater Lung Function Improvements in Patients With Chronic Rhinosinusitis With Nasal Polyps and Uncontrolled Asthma (EVEREST) With Dupilumab

Purpose: Patients with CRSwNP who have coexisting asthma are likely to have greater disease severity and burden. Dupilumab and omalizumab are approved for the treatment of inadequately controlled CRSwNP and uncontrolled moderate-to-severe asthma. Dupilumab, blocks the shared receptor component for interleukins 4 and 13, key and central drivers of type 2 inflammation in multiple diseases. Omalizumab targets immunoglobulin E. In the phase 4 EVEREST trial, dupilumab demonstrated greater efficacy than omalizumab, significantly improving CRSwNP-related outcomes and increasing pre-bronchodilator (BD) forced expiratory volume in 1 second by 153 mL (95% confidence interval [CI]: 52–255 mL), reflecting changes in large airways. Here, we report the efficacy of dupilumab vs omalizumab for additional lung function parameters in EVEREST. Methods: EVEREST (NCT04998604) is a multicenter, randomized, double-blind phase 4 clinical trial that evaluated the efficacy and safety of dupilumab vs omalizumab. Patients≥18 years of age with severe CRSwNP and coexisting uncontrolled asthma received background mometasone furoate nasal spray and were randomized 1:1 to receive add-on dupilumab 300 mg every 2 weeks or omalizumab 75–600 mg every 2 or 4 weeks for 24 weeks. Change from baseline in pre-BD forced expiratory flow at 25–75% of vital capacity (FEF 25–75% ) reflecting small airways and forced vital capacity (FVC) reflecting air trapping at Weeks 12 and 24 were analyzed with mixed-effect models with repeated measures. Results : Of the 360 patients enrolled in EVEREST, 181 were randomized to receive dupilumab and 179 to omalizumab. At Week 12, dupilumab vs omalizumab significantly improved pre-BD FEF 25–75% (least square mean difference vs omalizumab [95% CI] by 209 [65–352] mL/s), and improvements were sustained through Week 24 (199 [42–357] mL/s). Dupilumab vs omalizumab also significantly improved FVC after 12 (174 [76–272] mL) and 24 weeks of treatment (185 [73–298] mL). Conclusions : Dupilumab provides greater improvement than omalizumab for large and small airway lung function outcomes in patients with CRSwNP and uncontrolled coexisting asthma, which can be a surrogate for improved asthma control and reduced risk for exacerbations. Publication History Article published online: 04 March 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany