North East London has established a new NHS Rhinology and Biologics multidisciplinary team (MDT) for patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP). The pathway has now treated its first patient with dupilumab. As a result, selected patients now have another treatment option alongside established medical and surgical care.
A New Rhinology and Biologics MDT for North East London
Severe chronic rhinosinusitis with nasal polyps can be difficult to control. For example, some patients continue to have major symptoms despite nasal steroid treatment, courses of systemic corticosteroids and sinus surgery.
The new North East London NHS Rhinology and Biologics MDT gives specialists a dedicated regional forum to review complex cases together. Therefore, teams can consider previous treatment, current disease severity and the next treatment step in one structured pathway.
The North East London pathway has now treated its first patient with dupilumab for severe CRSwNP. In addition, the pathway aims to widen access to specialist review across a North East London population of more than 2.2 million people.
Importantly, biologic treatment does not replace the established rhinology pathway. Instead, it gives selected patients another evidence-based option when severe disease remains inadequately controlled.
What Is Chronic Rhinosinusitis With Nasal Polyps?
Chronic rhinosinusitis means long-term inflammation of the nose and sinuses. When nasal polyps are also present, doctors call the condition chronic rhinosinusitis with nasal polyps, or CRSwNP.
Nasal Blockage
Inflamed tissue and nasal polyps can narrow the nasal passages and make normal nasal breathing difficult.
Reduced Sense of Smell
A reduced or lost sense of smell is common. Consequently, the condition can have a major effect on everyday life.
Persistent Inflammation
Symptoms may continue for months or years. In some people, they also return after apparently successful treatment.
Recurring Disease
Some patients develop recurrent polyps or persistent symptoms after previous sinus surgery.
NICE describes severe CRSwNP as a potentially debilitating condition. Symptoms can include nasal blockage, reduced smell and taste, nasal discharge, facial symptoms, sleep disturbance and fatigue.
What Is Dupilumab?
Dupilumab is a biologic medicine. It targets specific signals involved in type 2 inflammation, which plays an important role in many people with severe CRSwNP.
How dupilumab fits into treatment
Dupilumab for nasal polyps is an add-on treatment. Therefore, it does not simply replace all other treatment. Patients will usually continue appropriate nasal treatment as part of their wider care plan.
Targeted Treatment
Biologics target selected parts of the immune inflammatory pathway. In contrast, nasal sprays and surgery work in different ways.
For Selected Patients
Dupilumab is not suitable for every person with nasal polyps. Instead, specialists assess disease severity, previous treatment and the relevant NHS and NICE criteria.
Part of Ongoing Care
Patients who receive a biologic still need specialist follow-up. The clinical team can then review symptoms, treatment response and the wider care plan.
One Option in a Wider Pathway
Medical treatment, endoscopic sinus surgery and biologic therapy can each have a role. However, the right sequence depends on the individual patient.
Who May Be Eligible for Dupilumab on the NHS in England?
In February 2026, NICE published technology appraisal guidance TA1134. The guidance recommends dupilumab as an option for certain adults with severe CRSwNP.
Key parts of the NICE criteria
Severe CRSwNP
The patient needs to have severe chronic rhinosinusitis with nasal polyps.
Disease Remains Uncontrolled
NICE includes disease that remains insufficiently controlled despite systemic corticosteroids or sinus surgery.
Previous Sinus Surgery
The recommendation includes adults who have already had at least one sinus operation.
SNOT-22 Assessment
NICE specifies a 22-item Sinonasal Outcome Test (SNOT-22) score of at least 50.
One feature alone does not make dupilumab the right treatment. Therefore, the team also considers the full history, previous treatment, examination findings, disease severity, other health conditions and local pathway requirements.
Complex Treatment Decisions Benefit From Multidisciplinary Review
A regional MDT allows clinicians to assess advanced treatment in the context of the patient’s complete rhinology history. As a result, the decision does not rest on a single medicine or one clinic visit.
Questions the MDT can consider
- Does the patient clearly have severe CRSwNP?
- Has the patient had an adequate trial of appropriate medical treatment?
- What sinus surgery has the patient already had, and what did it achieve?
- Would further sinus surgery help, or is a biologic now a reasonable option?
- Are there associated conditions, such as asthma or other type 2 inflammatory disease, that may affect the treatment plan?
- How should the team measure and review treatment response?
Modern severe CRSwNP care focuses on choosing the right treatment at the right stage. For some patients, that means continued medical treatment. For others, it may involve endoscopic sinus surgery, biologic therapy or a planned combination over time.
Why the North East London Pathway Is Important
NHS North East London serves more than 2.2 million people across seven boroughs. Therefore, a dedicated regional rhinology and biologics pathway can create a clearer route to specialist assessment for people with difficult-to-control disease.
Regional Review
Specialists can review complex cases through a shared regional pathway rather than relying only on decisions within one clinic.
Consistent Selection
MDT review can support a more consistent use of clinical criteria and evidence when the team considers biologic treatment.
Shared Expertise
A regional pathway allows clinicians to combine experience from rhinology services across North East London.
Long-Term Planning
Severe CRSwNP often needs ongoing care. Consequently, a structured pathway can support planned review rather than treating every recurrence as an isolated episode.
Where Does Dupilumab Fit Alongside Endoscopic Sinus Surgery?
The availability of dupilumab does not make endoscopic sinus surgery obsolete. Surgery remains an important treatment for many patients with chronic rhinosinusitis.
Surgery and biologics have different roles
For example, surgery can clear diseased tissue and improve access to the sinuses for topical treatment. However, repeat surgery is not automatically the best answer for every patient with recurrent severe polyps.
Biologic treatment therefore provides another option for selected people whose disease remains inadequately controlled after established treatment.
NICE guidance sets the NHS framework for access to dupilumab. The specialist team then decides whether the treatment fits the patient’s clinical circumstances.
What Should Someone With Severe Nasal Polyps Do?
Patients with persistent or recurrent symptoms should not assume that they need a biologic simply because nasal polyps have returned. Instead, the first step is a specialist review of the current disease and previous treatment.
Information to discuss with your specialist
- Explain which nasal treatments and systemic medicines you have already used.
- Tell the clinician about previous sinus operations and how long any improvement lasted.
- Ask how the team measures your symptoms and quality of life, including whether SNOT-22 assessment is appropriate.
- Ask whether specialist MDT review may help if severe disease remains uncontrolled.
Dupilumab is a prescription biologic treatment used within specialist care. Therefore, patients should continue prescribed treatment unless their clinical team advises a change.
An Important Development for Specialist Rhinology in North East London
The North East London NHS Rhinology and Biologics MDT represents an important service development for people with severe CRSwNP. Its first treatment with dupilumab marks the start of a regional pathway that brings advanced medical treatment into a structured multidisciplinary model.
More importantly, the development is not simply about adding one medicine. It creates a pathway in which specialists can consider medical treatment, surgery, disease severity, previous treatment and patient outcomes together.
Developing the North East London Pathway
Mr Hassan Elhassan has thanked colleagues across North East London who supported the development of the pathway, including Ahmed Eweiss, Sonna Ifeacho, Andreas Espehana, Amir Habeeb, Gaurav Kumar and Ahmed H. Allam.
Evidence and Further Information
- National Institute for Health and Care Excellence (NICE). Dupilumab for treating severe chronic rhinosinusitis with nasal polyps (TA1134). Published 18 February 2026.
- National Institute for Health and Care Excellence (NICE). Committee discussion: severe chronic rhinosinusitis with nasal polyps.
- European Medicines Agency. Dupixent (dupilumab): European Public Assessment Report.
- NHS North East London. North East London People and Culture Strategy 2024–2028.
- Hassan Elhassan. North East London Rhinology and Biologics MDT announcement.