Biologics for Chronic Rhinosinusitis With Nasal Polyposis: Current Landscape and Future Directions

Abstract

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a type 2 inflammatory disease that often persists despite medical and surgical treatments. Recently, biologic therapies targeting key cytokines—interleukin (IL)-4, IL-5, IL-13—and immunoglobulin E (IgE) have transformed management options for patients with severe or recurrent disease. Dupilumab, omalizumab, and mepolizumab are FDA-approved biologics proven to reduce polyp size, improve symptoms, and enhance quality of life in clinical trials. Guidelines now endorse the use of biologics in select patients with evidence of type 2 inflammation and inadequate control after standard treatments. However, challenges remain, including high costs, uncertain treatment duration, lack of direct comparisons, and absence of validated biomarkers to guide selection. Additionally, the optimal role of biologics relative to endoscopic sinus surgery is not yet clear. Emerging therapies—including long-acting anti–IL-5 agents and new targets like TSLP and IL-33—may further broaden options. Research is also needed for patients with non-type two inflammation who respond poorly to current treatments. Ultimately, personalized approaches based on disease phenotype and biomarkers are crucial to optimizing outcomes. This review summarizes current evidence and future directions for biologic use in CRSwNP, focusing on efficacy, patient selection, surgery integration, and precision medicine opportunities.