Medications and new therapies for chronic rhinosinusitis: a narrative review

Purpose: Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disease of the upper airways, encompassing distinct endotypes and phenotypes. Among these, chronic rhinosinusitis with nasal polyps (CRSwNP) frequently involves type 2 inflammation and tends to recur despite conventional treatments. This review aims to summarize current pharmacologic strategies for CRS management, with a focus on the emerging role of biologics as precision medicine.Current Concepts: Standard pharmacologic treatments for CRS include saline irrigation, intranasal corticosteroids, short-term systemic steroids, macrolide antibiotics, leukotriene antagonists, and, in select cases, bacterial lysates. These therapies target mucosal inflammation and symptom relief, often serving as adjuncts to endoscopic sinus surgery. Recently, biologics such as dupilumab, omalizumab, and mepolizumab have been approved for CRSwNP, offering targeted inhibition of the interleukin (IL)-4/IL-13, immunoglobulin E, and IL-5 pathways, respectively. Clinical trials and real-world studies have demonstrated their efficacy in reducing polyp size, improving quality of life, restoring olfaction, and reducing the need for surgery in type 2 inflammation-dominant CRSwNP.Discussion and Conclusion: Biologics represent a paradigm shift in the management of CRS, particularly in refractory CRSwNP. However, issues regarding cost, insurance coverage, optimal treatment duration, and criteria for switching or discontinuation remain unresolved. Future research should focus on identifying predictive biomarkers, establishing practical guidelines specific to Korea, and validating the real-world cost-effectiveness of these guidelines. A personalized treatment strategy based on endotype classification, that integrates pharmacologic and biologic therapies, may improve long-term outcomes in patients with CRS.