Chronic Rhinosinusitis Optimisation of Nasal Outcomes and Scores (CHRONOS): An Italian Delphi Consensus on Long-Term Management with Biologics

Eugenio De Corso¹, Frank Rikki Mauritz Canevari^{2

3}, Marco Caminati^{4

5}, Carlotta Pipolo⁶, Enrico Heffler^{7

8}, Matteo Lazzeroni^{9

10}, Veronica Seccia¹¹, Massimiliano Garzaro¹², Giancarlo Ottaviano¹³, Elena Cantone^{14

15}, Fabio Pagella^{16

17}, Giulia Gramellini¹⁸, Ignazio La Mantia¹⁹, Stefania Gallo^{20

21}, Antonio Moffa^{22

23}, Ernesto Pasquini²⁴, Antonella Loperfido²⁵, Sara Torretta²⁶, Lorenzo Cecchi²⁷, Gian Luca Fadda²⁸, Giandomenico Maggiore²⁹, Stefano Pelucchi³⁰, Lucia Iannuzzi³¹, Daniela Lucidi³², Alberto Macchi^{20

21}, Roberto Padoan³³, Vincenzo Patella^{34

35}, Giulia Dané³⁶, Jan Schroeder³⁷, Claudio Montuori³⁸, Marco Corbò^{1

38}, Giorgio Walter Canonica^{7

8}, Gianenrico Senna^{39

40}

Affiliations

¹ Unit of Otorhinolaryngology and Head-Neck Surgery, A Gemelli University Hospital Foundation IRCCS, Rome, Italy.
² Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
³ Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
⁴ Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy. marco.caminati@univr.it.
⁵ Department of Medicine, University of Verona, Verona, Italy. marco.caminati@univr.it.
⁶ Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Milan, Italy.
⁷ Department of Biomedical Science, Humanitas University, Pieve Emanuele (Milan), Italy.
⁸ Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy.
⁹ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
¹⁰ Department of Otorhinolaryngology & Head and Neck Surgery, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milan, Italy.
¹¹ Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, OtolaryngologyPisa, Italy.
¹² ENT Division, Eastern Piedmont University Hospital of Novara, Novara, Italy.
¹³ Otolaryngology Section, Department of Neurosciences, University of Padova, Padua, Italy.
¹⁴ Otolaryngology Unit Department of Pharmacy and Health and Nutrition Sciences, University of Calabria, Rende, Italy.
¹⁵ Otolaryngology Unit, Annunziata Hospital, Cosenza, Italy.
¹⁶ Department of Surgical Pediatric Science, University of Pavia, Pavia, Italy.
¹⁷ Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
¹⁸ Otolaryngology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
¹⁹ Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy.
²⁰ Unit of Otorhinolaryngology, Head and Neck Department, ASST Sette Laghi, Varese, Italy.
²¹ UPLOAD (Upper and Lower Airways Diseases) Research Centre, Varese, Italy.
²² School of Medicine, Università Campus Bio-Medico, Rome, Italy.
²³ Integrated Therapies in Otolaryngology, Fondazione Policlinico Campus Bio- Medico, Rome, Italy.
²⁴ ENT Unit, Bellaria Hospital, Azienda USL Bologna, Bologna, Italy.
²⁵ Otolaryngology Unit, San Camillo Forlanini Hospital, Rome, Italy.
²⁶ Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
²⁷ Allergology and Clinical Immunology, S Giovanni Di Dio Hospital, Florence, Italy.
²⁸ Department of Otorhinolaryngology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy.
²⁹ Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy.
³⁰ Otorhinolaryngology and Audiology Unit, Department of Neurosciences and Rehabilitation, University of Study of Ferrara, Ferrara, Italy.
³¹ Department of Biomedical Sciences, Neurosciences and Sense Organs, ENT Clinic, University of Bari, Bari, Italy.
³² Bologna University- ENT Department Ravenna Hospital, Bologna, Italy.
³³ Department of Medicine DIMED, Rheumatology Unit, University of Padua, Padua, Italy.
³⁴ Department of Internal Medicine ASL Salerno, 'Santa Maria Della Speranza' Hospital, Battipaglia, Italy.
³⁵ Postgraduate Program in Allergy and Clinical Immunology, University of Naples 'Federico II', Naples, Italy.
³⁶ Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
³⁷ Allergology and Clinical Immunology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
³⁸ Università Cattolica Del Sacro Cuore, Istituto Di Otorinolaringoiatria, Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
³⁹ Department of Medicine, University of Verona, Verona, Italy.
⁴⁰ Allergy Unit, Pederzoli Hospital, Peschiera, Verona, Italy.

PMID: 41507601
DOI: 10.1007/s11882-025-01246-1

Review

Chronic Rhinosinusitis Optimisation of Nasal Outcomes and Scores (CHRONOS): An Italian Delphi Consensus on Long-Term Management with Biologics

Eugenio De Corso et al. Curr Allergy Asthma Rep. 2026.

. 2026 Jan 9;26(1):3.

doi: 10.1007/s11882-025-01246-1.

Authors

Affiliations

¹ Unit of Otorhinolaryngology and Head-Neck Surgery, A Gemelli University Hospital Foundation IRCCS, Rome, Italy.
² Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
³ Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
⁴ Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy. marco.caminati@univr.it.
⁵ Department of Medicine, University of Verona, Verona, Italy. marco.caminati@univr.it.
⁶ Otolaryngology Unit, Department of Health Sciences, Santi Paolo E Carlo Hospital, Università Degli Studi Di Milano, Milan, Italy.
⁷ Department of Biomedical Science, Humanitas University, Pieve Emanuele (Milan), Italy.
⁸ Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy.
⁹ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
¹⁰ Department of Otorhinolaryngology & Head and Neck Surgery, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milan, Italy.
¹¹ Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, OtolaryngologyPisa, Italy.
¹² ENT Division, Eastern Piedmont University Hospital of Novara, Novara, Italy.
¹³ Otolaryngology Section, Department of Neurosciences, University of Padova, Padua, Italy.
¹⁴ Otolaryngology Unit Department of Pharmacy and Health and Nutrition Sciences, University of Calabria, Rende, Italy.
¹⁵ Otolaryngology Unit, Annunziata Hospital, Cosenza, Italy.
¹⁶ Department of Surgical Pediatric Science, University of Pavia, Pavia, Italy.
¹⁷ Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
¹⁸ Otolaryngology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
¹⁹ Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy.
²⁰ Unit of Otorhinolaryngology, Head and Neck Department, ASST Sette Laghi, Varese, Italy.
²¹ UPLOAD (Upper and Lower Airways Diseases) Research Centre, Varese, Italy.
²² School of Medicine, Università Campus Bio-Medico, Rome, Italy.
²³ Integrated Therapies in Otolaryngology, Fondazione Policlinico Campus Bio- Medico, Rome, Italy.
²⁴ ENT Unit, Bellaria Hospital, Azienda USL Bologna, Bologna, Italy.
²⁵ Otolaryngology Unit, San Camillo Forlanini Hospital, Rome, Italy.
²⁶ Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
²⁷ Allergology and Clinical Immunology, S Giovanni Di Dio Hospital, Florence, Italy.
²⁸ Department of Otorhinolaryngology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy.
²⁹ Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy.
³⁰ Otorhinolaryngology and Audiology Unit, Department of Neurosciences and Rehabilitation, University of Study of Ferrara, Ferrara, Italy.
³¹ Department of Biomedical Sciences, Neurosciences and Sense Organs, ENT Clinic, University of Bari, Bari, Italy.
³² Bologna University- ENT Department Ravenna Hospital, Bologna, Italy.
³³ Department of Medicine DIMED, Rheumatology Unit, University of Padua, Padua, Italy.
³⁴ Department of Internal Medicine ASL Salerno, 'Santa Maria Della Speranza' Hospital, Battipaglia, Italy.
³⁵ Postgraduate Program in Allergy and Clinical Immunology, University of Naples 'Federico II', Naples, Italy.
³⁶ Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
³⁷ Allergology and Clinical Immunology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
³⁸ Università Cattolica Del Sacro Cuore, Istituto Di Otorinolaringoiatria, Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
³⁹ Department of Medicine, University of Verona, Verona, Italy.
⁴⁰ Allergy Unit, Pederzoli Hospital, Peschiera, Verona, Italy.

PMID: 41507601
DOI: 10.1007/s11882-025-01246-1

Abstract

Purpose of review: This review synthesizes current evidence and expert consensus on the long-term management of severe chronic rhinosinusitis with nasal polyps (CRSwNP) treated with biologics, as established by the Italian CHRONOS project.

Recent findings: Accumulating real-world and clinical trial data confirm the sustained efficacy and safety of biologics targeting type 2 inflammation, enabling durable control and remission in a significant proportion of patients. Personalized dosing regimens, including dose-spacing strategies, appear feasible. The CHRONOS project provides practical guidance for optimizing long-term biologic therapy in severe CRSwNP. Response assessment should combine subjective and objective measures, especially for olfactory testing. Biologics may be considered before surgery only in selected complex cases. Dose-spacing strategies may be appropriate in stable patients but require multidisciplinary oversight in those with comorbid asthma. Adverse events are uncommon. The concept of disease modification is endorsed, recognizing biologics' potential to alter the natural history of CRSwNP.

Keywords: Biological therapy; Chronic rhinosinusitis with nasal polyps; Disease modification; Dupilumab; Long-term management; Mepolizumab; Omalizumab; Remission; Type 2 inflammation.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflicts of Interest: The authors declare no competing interests. Human and Animal Rights and Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors.

References

1. Bachert C, Hellings PW, Mullol J, Hamilos DL, Gevaert P, Naclerio RM, et al. Dupilumab improves health-related quality of life in patients with chronic rhinosinusitis with nasal polyposis. Allergy. 2020;75(1):148–57. https://doi.org/10.1111/all.13984 . - DOI - PubMed
1. Lourijsen ES, Fokkens WJ, Reitsma S. Direct and indirect costs of adult patients with chronic rhinosinusitis with nasal polyps. Rhinology. 2020;58(3):213–7. https://doi.org/10.4193/Rhin19.468 . - DOI - PubMed
1. Fokkens WJ, Viskens AS, Backer V, Conti D, De Corso E, Gevaert P, et al. EPOS/EUFOREA update on indication and evaluation of biologics in chronic rhinosinusitis with nasal polyps 2023. Rhinology. 2023;61(3):194–202. https://doi.org/10.4193/Rhin22.489 . - DOI - PubMed
1. Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(Suppl S29):1–464. https://doi.org/10.4193/Rhin20.600 . - DOI - PubMed
1. Cai S, Xu S, Zhao Y, Zhang L. Efficacy and safety of biologics for chronic rhinosinusitis with nasal polyps: a meta-analysis of real-world evidence. Allergy. 2025;80(5):1256–70. https://doi.org/10.1111/all.16499 . - DOI - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions

LinkOut - more resources

Full Text Sources
- Springer
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Chronic Rhinosinusitis Optimisation of Nasal Outcomes and Scores (CHRONOS): An Italian Delphi Consensus on Long-Term Management with Biologics

Affiliations

Chronic Rhinosinusitis Optimisation of Nasal Outcomes and Scores (CHRONOS): An Italian Delphi Consensus on Long-Term Management with Biologics

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical