Biologic Therapies in Chronic Rhinosinusitis with Nasal Polyps
Summary
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a relapsing inflammatory disorder of the sinonasal mucosa characterised by polyp formation and persistent sinonasal symptoms. Predominantly driven by type 2 inflammation, CRSwNP involves dysregulated production of cytokines such as interleukin-4, interleukin-5 and interleukin-13, leading to eosinophil recruitment, mucosal oedema and polyp growth. Conventional management relies on intranasal and systemic corticosteroids, often coupled with endoscopic sinus surgery, yet recurrence rates remain high and many patients experience ongoing symptom burden. In recent years, precision-targeted biologic agents—monoclonal antibodies directed against specific cytokines or receptors—have transformed the therapeutic landscape by attenuating type 2 immune pathways. Agents directed at the interleukin-4 receptor α, interleukin-5, interleukin-5 receptor α and immunoglobulin E have demonstrated reductions in polyp size, improvements in nasal obstruction and sense of smell, and decreased reliance on systemic corticosteroids or revision surgery. These therapies represent a shift towards personalised care, offering sustained disease control for patients with severe, refractory CRSwNP and associated comorbidities such as asthma and aspirin-exacerbated respiratory disease. Continued research seeks to refine patient selection, identify predictive biomarkers and evaluate long-term safety and cost-effectiveness in diverse healthcare settings.
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Biologic Therapies in Chronic Rhinosinusitis with Nasal Polyps publication trend
The graph below shows the total number of articles in biologic therapies in chronic rhinosinusitis with nasal polyps across all publications each year (not limited to Nature Index journals).
Technical terms
Biologic therapy: A treatment using engineered monoclonal antibodies to modulate specific components of the immune system.
Type 2 inflammation: An immunological response characterised by cytokines IL-4, IL-5 and IL-13, leading to eosinophil activation and allergy-related pathology.
Monoclonal antibody: A laboratory-made protein designed to bind with high specificity to a single target antigen, such as a cytokine or its receptor.
Eosinophil: A type of white blood cell that contributes to tissue inflammation and is prominently elevated in CRSwNP.
Nasal Polyp Score: A clinician-rated scale assessing the size and extent of nasal polyps via endoscopic examination.
References
- The interleukin-4/interleukin-13 pathway in type 2 inflammation in chronic rhinosinusitis with nasal polyps. Frontiers in Immunology (2024).
- Effectiveness of Dupilumab in the Treatment of Patients with Severe Uncontrolled CRSwNP: A “Real-Life” Observational Study in the First Year of Treatment. Journal of Clinical Medicine (2022).
- Mepolizumab for chronic rhinosinusitis with nasal polyps: Treatment efficacy by comorbidity and blood eosinophil count. Journal of Allergy and Clinical Immunology (2022).
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