Baseline Inflammatory Biomarkers and Disease Burden for Predicting Response to Stapokibart in CRSwNP

Background: Stapokibart is a novel biologic for chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to identify baseline biomarkers predicting early (4-week) and mid-term (16-week) responses to stapokibart in CRSwNP. Methods: A total of 57 patients were prospectively enrolled. Baseline clinical data and complete blood count (CBC) parameters were collected, and derived inflammatory indices were calculated. Patients were classified as responders or non-responders at week 4 and 16 based on achieving either a ≥8.9-point reduction in SNOT-22 or a ≥1-point decrease in Nasal Polyp Score (NPS). Results: Stapokibart significantly improved SNOT-22, VAS, and NPS at both week 4 and week 16 (all p < 0.001). At week 4, 80.7% achieved an early response. Responders showed significantly higher baseline eosinophil count and eosinophil percentage and lower neutrophil-to-eosinophil ratio (N/E) (all p < 0.05). Univariate analysis identified N/E, comorbid asthma, eosinophil count, and aggregate index of systemic inflammation (AISI) as predictors of early response (all p < 0.05). Multivariate analysis identified N/E as an independent predictor (OR = 0.943, p = 0.011; AUC = 0.756). At week 16, 75.4% of patients achieved a mid-term response. Responders had significantly higher baseline SNOT-22 scores and NPS (p < 0.05). Multivariate analysis showed that baseline NPS and SNOT-22 scores were independently associated with mid-term response, and their combined model showed good predictive performance (AUC = 0.832, 95% CI: 0.716–0.948). Conclusions: Peripheral blood inflammatory biomarkers, particularly N/E, may predict early response to stapokibart in CRSwNP, whereas mid-term response appears more strongly associated with baseline disease severity. These findings support biomarker-driven stratification for individualized treatment strategies in CRSwNP.