A significantly greater proportion of patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) and coexisting uncontrolled asthma achieved composite asthma clinical remission at week 24 with dupilumab (Dupixent) than with omalizumab (Xolair), according to an analysis of the phase 4 EVEREST trial presented at the European Respiratory Society (ERS) 2026 Congress in Barcelona.1
EVEREST is the first head-to-head trial comparing 2 approved biologics in this overlapping upper and lower airway population.2 Topline efficacy results were published in The Lancet Respiratory Medicine in December 2025, and the new analysis extends those findings by evaluating a composite asthma remission endpoint incorporating exacerbations, oral corticosteroid (OCS) use, lung function stability, and symptom control.2 Guy Brusselle, MD, PhD, of Ghent University Hospital in Belgium, discussed the trial design and findings with HCPLive.
“Although the active comparator is not [a] placebo but an active treatment, omalizumab, the dupilumab-treated group has a more profound benefit, and the difference between these 2 active treatments is above the MCID, the minimal clinically important difference,” Brusselle said. “So, [these are] very intriguing results.”
Dupilumab Achieves Greater Asthma Clinical Remission Rates in EVEREST
EVEREST randomized 360 adults with severe CRSwNP and coexisting asthma of any severity 1:1 to subcutaneous dupilumab 300 mg every 2 weeks (n = 181) or weight- and IgE-tiered omalizumab 75-600 mg every 2 or 4 weeks (n = 179) for 24 weeks, on a background of inhaled corticosteroids, intranasal corticosteroids, and a second asthma controller.1,2 Patients were stratified by type 2 inflammatory status, defined as baseline eosinophils of ≥ 150 cells/µL or fractional exhaled nitric oxide of ≥ 25 ppb. Mean age was 52 years, with a mean 13-year duration of CRSwNP and adult-onset asthma beginning around age 35 years, Bruselle said.
In the prespecified remission analysis, patients were classified by whether they met a composite asthma clinical remission endpoint at week 24, defined as absence of asthma-related exacerbations, no OCS use, stable or improved FEV1 (≤ 5% decline from baseline), and an Asthma Control Questionnaire-5 (ACQ-5) score of ≤ 1.5.1 A significantly greater percentage of dupilumab-treated patients met all 4 criteria compared with omalizumab, at 64% (112 of 175) versus 40.5% (70 of 173) (P <.0001).1
Nasal Polyp Score, Smell, and Lung Function Outcomes in EVEREST
Regardless of whether patients met remission criteria, dupilumab produced greater improvement than omalizumab in objective upper airway measures. Bruselle said that nasal polyp score fell by nearly 3 points with dupilumab compared with roughly 1 point with omalizumab at week 24 (P <.0001) University of Pennsylvania Smell Identification Test scores improved to a significantly greater extent with dupilumab as well (P <.0001).1
The pattern extended to lower airway outcomes. Dupilumab produced a more pronounced increase in pre-bronchodilator FEV1 than omalizumab, and SNOT-22 scores improved more with dupilumab as well. ACQ-7 scores declined by nearly 2 points with dupilumab versus approximately 1.5 points with omalizumab, with the treatment difference exceeding the minimal clinically important difference for the outcome, Bruselle said.
The full EVEREST dataset, including additional lung function parameters, was presented separately at the 2025 CHEST Annual Meeting, reinforcing dupilumab's comparative benefit across large and small airway outcomes in this population.³ Under the trial's protocol, clinical asthma remission is only confirmed once criteria are sustained through week 52, and longer-term follow-up is anticipated.1
References
Brusselle G, Heffler E, Busse WW, et al. Clinical asthma remission and nasal polyp outcomes over 24 weeks with dupilumab versus omalizumab in patients with severe chronic rhinosinusitis with nasal polyps and uncontrolled asthma: results from EVEREST. Presented at: European Respiratory Society (ERS) Congress 2026; September 5-9, 2026; Barcelona, Spain.
De Corso E, Canonica GW, Heffler E, et al. Dupilumab versus omalizumab in patients with chronic rhinosinusitis with nasal polyps and coexisting asthma (EVEREST): a multicentre, randomised, double-blind, head-to-head phase 4 trial. Lancet Respir Med. 2025;13(12):1067-1077. doi:10.1016/S2213-2600(25)00287-5
