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Review
. 2025 May;155(5):1401-1410.
doi: 10.1016/j.jaci.2025.03.011. Epub 2025 Mar 23.

Clinical efficacy and mechanisms of biologics for chronic rhinosinusitis with nasal polyps

Radomir Kratchmarov  1 , Tiffany Dharia  1 , Kathleen Buchheit  2
Affiliations
Review

Clinical efficacy and mechanisms of biologics for chronic rhinosinusitis with nasal polyps

Radomir Kratchmarov et al. J Allergy Clin Immunol. 2025 May.

Abstract

The management of chronic rhinosinusitis with nasal polyps (CRSwNP) can be challenging, particularly when standard treatments including intranasal corticosteroids and endoscopic sinus surgery do not result in adequate symptom control. CRSwNP is frequently characterized by a type 2 immune signature, and many patients have other comorbid type 2 conditions, including asthma. There are currently 3 biologic therapies approved for the treatment of CRSwNP-omalizumab, mepolizumab, and dupilumab-and there are promising therapies in development. Biologic therapies allow for improved patient quality of life in CRSwNP, reduction in need for systemic corticosteroid treatment and endoscopic sinus surgery, and improvement in treatment of comorbidities. Translational studies assessing how biologic therapies can modify inflammation in CRSwNP have allowed for a greater understanding of CRSwNP pathogenesis. We review CRSwNP clinical trial and real-world data on the effectiveness and safety of biologics, discuss their therapeutic mechanisms, assess outcomes of biologic therapy versus endoscopic sinus surgery, and discuss therapies in development and future directions.

Keywords: CRSsNP; CRSwNP; Chronic rhinosinusitis; benralizumab; biologic; dupilumab; mepolizumab; nasal polyp; omalizumab; tezepelumab.

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Conflict of interest statement

Disclosure statement Supported by the National Institutes of Health (grants K23AI139352, T32AI007306), and by generous contributions from the Vinik and Kaye families. Disclosure of potential conflict of interest: K. Buchheit has served on scientific advisory boards for AstraZeneca, Regeneron, Sanofi Genzyme, Eli Lilly, and GlaxoSmithKline; receives research grants from Regeneron; and receives royalties from UpToDate. The rest of the authors declare that they have no relevant conflicts of interest.

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