Abstract Purpose of Review Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease that may be refractory to conventional medical and surgical therapies. Advances in the understanding of type 2 inflammatory mechanisms have led to the development of targeted biologic therapies. This review examines clinical trial evidence, and real-world data supporting biologic use in CRSwNP. Recent Findings Four biologics (dupilumab, omalizumab, mepolizumab, tezepelumab) are FDA approved in the United States for the management of refractory CRSwNP. Randomized controlled trials and multiple additional studies have demonstrated the efficacy of biologics in reducing nasal polyp burden and nasal congestion in patients who are refractory to traditional medical/surgical therapy or are poor surgical candidates. Guidelines for implementing these drugs into daily practice emphasize the importance of identifying appropriate patient subgroups, considering patient inflammatory profiles and comorbid conditions to select the best agent, and reassessing drug response to optimize resources and ensure patient safety. Summary Biologics uniquely contribute to CRSwNP management by modulating the underlying type 2 inflammatory pathway cascade in patients who are otherwise refractory to conventional medical and surgical therapy. Ongoing and future trials will refine biomarker-guided therapy and define the role of biologics alongside surgery in comprehensive CRSwNP care.
Kilgore et al. (Wed,) studied this question.