Preoperative Stapokibart for Endoscopic Sinus Surgery in Chronic Rhinosinusitis With Nasal Polyps

Inclusion Criteria:

• Possess the ability to understand the nature of the study and voluntarily sign an informed consent form (ICF);
• Age between 18 and 75 years old, with no limitation on gender;
• Bilateral CRSwNP meeting the diagnostic criteria of the Chinese Guidelines for the Diagnosis and Treatment of Chronic Sinusitis (2024);
• Persistent presence of the following symptoms for ≥12 weeks prior to the screening/introduction period:
• Nasal congestion;
• Any other symptom such as decreased/loss of smell or rhinorrhea;
• At the screening/introduction period and baseline, total NPS ≥ 4 points and NPS ≥ 2 points in each nasal cavity;
• At the screening/introduction period and baseline, the subject reports moderate to severe nasal congestion or decreased smell (NCS or LoS score of 2 or 3 points);
• During the screening/introduction period, the Lund-Mackay score on sinus CT is ≥12 points bilaterally and ≥6 points unilaterally;
• Must meet any of the following criteria for type 2 inflammation: Eosinophil count >55/high-power field or eosinophil percentage >27% in nasal polyp tissue during the induction period; eosinophil percentage ≥3.75% in peripheral blood in patients with asthma; eosinophil percentage ≥6.9% in patients without asthma;
• If the subject has asthma, the condition must be stable as assessed by the investigator or specialist. For subjects treated with a stable dose of inhaled corticosteroids for at least 4 weeks before screening, the treatment may be continued during the study period, and the daily dose of inhaled corticosteroids must be ≤1000 μg fluticasone propionate or an equivalent dose of other inhaled corticosteroids.

Exclusion Criteria:

• Previous ESS surgery including but not limited to septoplasty, turbinate reduction, nasal polyp removal, and sinus surgery;
• Contraindications to general anesthesia;
• Contraindications to stapokibart therapy;
• Previous use of any anti-IL-4Rα biologic;
• The patient has conditions or comorbidities that may prevent them from being evaluated for the primary efficacy endpoint, such as acute rhinitis, nasal infection or upper respiratory tract infection within 2 weeks prior to the screening period, acute asthma exacerbation within 4 weeks, current drug-induced rhinitis, allergic fungal sinusitis (AFRS), benign or malignant nasal tumors;
• Important clinical comorbidities that may interfere with clinical efficacy results, including but not limited to active upper or lower respiratory tract infection, cystic fibrosis, eosinophilic granuloma with polyangiitis (Churg-Strauss syndrome), granuloma with polyangiitis (Wegener's granulomatosis), Young's syndrome, etc.;
• Accompanied by other poorly controlled serious diseases or recurrent chronic diseases such as (but not limited to) active infection, cardiovascular disease, tuberculosis or other pathogen infection, diabetes, autoimmune diseases, HIV, hepatitis B, hepatitis C or parasitic diseases, malignant tumors, etc.;
• Subjects with severe liver or kidney dysfunction, such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels > 2 times the upper limit of normal, and serum creatinine > the upper limit of normal;
• Subjects with known or suspected immunosuppression, including those with a history of invasive opportunistic infections (such as tuberculosis, histoplasmosis, listeriosis, coccidioidomycosis, pulmonary cystitis, aspergillosis), even if the infection has subsided;
• Women who are pregnant or planning to become pregnant during the study period, or who are breastfeeding;
• Subjects of childbearing age who do not wish to use medically approved effective contraception;
• Subjects with a history of alcohol or drug abuse;
• Subjects deemed by the investigator to have other medical or non-medical conditions that make them unsuitable for participation in this study.