Introduction: Severe chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease that significantly impairs quality of life. Biologic therapies offer targeted treatment options; however, comparative data remain limited. Methods: A systematic review and Bayesian network meta-analysis of randomized controlled trials (RCTs) was conducted to compare the efficacy and safety of approved biologics in adults with CRSwNP. Primary outcomes included changes in the Nasal Polyp Score (NPS), SNOT-22 score, and the incidence of serious adverse events (SAEs). Surface under the cumulative ranking (SUCRA) values were used to rank treatment performance. Results: Eight RCTs involving 2,564 patients were included. All biologics significantly reduced NPS and SNOT-22 scores compared to placebo. Dupilumab showed the greatest reduction in NPS (mean difference MD: -2.4; 95% credible interval CrI: -2.4 to -2.4) and SNOT-22 (MD: -19.2; 95% CrI: -19.2 to -19.1), followed by Tezepelumab (NPS MD: -2.1; 95% CrI: -2.1 to -2.0; SNOT-22 MD: -17.0; 95% CrI: -17.1 to -16.9). GR1802 ranked highest in safety, with the lowest odds of SAEs (odds ratio OR: 0.06; 95% CrI: 0.001 to 1.0), followed by Dupilumab (OR: 0.58; 95% CrI: -0.06 to 5.5). SUCRA values confirmed Dupilumab (0.807) and Tezepelumab (0.730) as the top performers in terms of efficacy, and GR1802 (0.954) as the safest option. The certainty of the evidence was high, and the risk of bias was low across most studies. Conclusion: Biologic therapies improve symptoms and reduce polyp burden in CRSwNP. Dupilumab and Tezepelumab are the most effective agents, while GR1802 demonstrates the highest safety profile. These findings support the use of individualized treatment based on specific clinical goals. Further head-to-head trials are warranted to better guide therapeutic decision-making.
Zheng et al. (Mon,) studied this question.