{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:50:52Z","timestamp":1789541452128,"version":"build-2803163510"},"reference-count":48,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T00:00:00Z","timestamp":1722988800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The indications for endoscopic modified Lothrop procedure (Draf 3) in patients with refractory chronic rhinosinusitis with nasal polyposis (CRSwNP) remain unclear. This study evaluates the effectiveness of Draf 3 for refractory CRSwNP focusing on improvements in disease severity and need for subsequent dupilumab rescue therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective review of patients with CRSwNP undergoing Draf 3 surgery at a tertiary center between 2012 and 2022. Clinicodemographic variables were compared across those who did versus did not require rescue with postoperative dupilumab. Time to postoperative dupilumab rescue was analyzed and longitudinal disease\u2010specific outcomes were measured using the sinonasal outcomes test (SNOT\u201022).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Within 87 patients with CRSwNP, 24.1% had aspirin\u2010exacerbated respiratory disease (AERD). Significant improvement in SNOT\u201022 score was found in CRSwNP with AERD (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001) and without AERD (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.01) up to 24 months postoperative. 14.9% eventually required rescue with a dupilumab. More specifically, of 21 patients with AERD, 24.1% eventually required rescue with dupilumab. Dupilumab rescue was associated with a greater number of prior sinus surgeries (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.02), prior aspirin desensitization (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.02), and worse preoperative Lund\u2010MacKay scores (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). No association between biologic rescue and frontal recess antero\u2010posterior diameter was found (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.20).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Draf 3 surgery in CRSwNP was associated with significant improvement in SNOT\u201022 score at 24 months. Furthermore, only 14.9% of patients required dupilumab rescue. Patients with AERD were more likely to require rescue with dupilumab even though 75.1% avoided treatment with the biologic over the study period.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.23424","type":"journal-article","created":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T14:39:37Z","timestamp":1723041577000},"page":"1849-1856","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Rate of dupilumab use and symptom severity of patients with chronic rhinosinusitis with nasal polyposis after Draf 3 frontal sinusotomy"],"prefix":"10.1002","volume":"14","author":[{"given":"Keven","family":"Ji","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hunter","family":"Kellerman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head &amp; Neck Surgery School of Medicine Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5009-3426","authenticated-orcid":false,"given":"Jess C.","family":"Mace","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Division of Rhinology and Sinus Surgery Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6424-7083","authenticated-orcid":false,"given":"Timothy L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Division of Rhinology and Sinus Surgery Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara 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