Biological Treatments and Surgical Interventions for Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review of Clinical Outcomes-Scilight

ENT Updates

Review

Biological Treatments and Surgical Interventions for Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review of Clinical Outcomes

Downloads

https://doi.org/10.54963/entu.v15i2.1138
Turki Hamdan, Kawther Ahmad, Hanin Mohamad, Shatha Mohammed, Mohammed Hamoh, Leena Faisal, Atyaf Mohammed, Sumayyah Abdullah, Mohammed AlHelali, Renad Alassaf, Sarah Alobaidan, Fawaz Dawood, Ali Awad, Sanad Jamaan, & Bader Ayed. (2025). Biological Treatments and Surgical Interventions for Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review of Clinical Outcomes. ENT Updates, 15(2), 23–36. https://doi.org/10.54963/entu.v15i2.1138
Volume 15 Issue 2 (2025)
Copyright (c) 2025 Turki Hamdan, Kawther Ahmad, Hanin Mohamad, Shatha Mohammed, Mohammed Hamoh, Leena Faisal, Atyaf Mohammed, Sumayyah Abdullah, Mohammed AlHelali, Renad Alassaf, Sarah Alobaidan, Fawaz Dawood, Ali Awad, Sanad Jamaan, Bader Ayed
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors

  • Turki Hamdan

    Department of Doctor of Pharmacy, College of Pharmacy, University of Hafr Al Batin, Hafar Al Batin 39524, Saudi Arabia
  • Kawther Ahmad

    Department of Doctor of Pharmacy, University of Tabuk, Tabuk 47512, Saudi Arabia
  • Hanin Mohamad

    Department of Doctor of Pharmacy, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
  • Shatha Mohammed

    Department of Doctor of Pharmacy, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
  • Mohammed Hamoh

    Department of Doctor of Pharmacy, College of Pharmacy, Umm-Al-Qura University, Makkah 24382, Saudi Arabia
  • Leena Faisal

    Department of Doctor of Pharmacy, College of Pharmacy, University of Hafr Al Batin, Hafar Al Batin 39524, Saudi Arabia
  • Atyaf Mohammed

    Department of Doctor of Pharmacy, College of Pharmacy, University of Hafr Al Batin, Hafar Al Batin 39524, Saudi Arabia
  • Sumayyah Abdullah

    Department of Doctor of Pharmacy, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
  • Mohammed AlHelali

    Department of Internal Medicine, College of Medicine, King Khalid University, Abha 62521, Saudi Arabia
  • Renad Alassaf

    Department of Doctor of Pharmacy, College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia
  • Sarah Alobaidan

    Department of Doctor of Pharmacy, University of Tabuk, Tabuk 47512, Saudi Arabia
  • Fawaz Dawood

    Department of Public Health, Rafha Central Hospital, Northern Border Health Cluster, Rafha 76321, Saudi Arabia
  • Ali Awad

    Department of Public Health, Rafha Central Hospital, Northern Border Health Cluster, Rafha 76321, Saudi Arabia
  • Sanad Jamaan

    Department of Public Health, Rafha Central Hospital, Northern Border Health Cluster, Rafha 76321, Saudi Arabia
  • Bader Ayed

    Department of Public Health, Rafha Central Hospital, Northern Border Health Cluster, Rafha 76321, Saudi Arabia

Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a chronic inflammatory condition of the nasal and paranasal sinus mucosa with nasal polyp formation. This systematic review evaluated the efficacy and safety of biological therapies, including omalizumab, mepolizumab, and benralizumab, compared with endoscopic sinus surgery (ESS) in CRSwNP management. A literature search using the PubMed, Scopus, and Web of Science databases identified five studies that met the inclusion criteria. The studies included randomized controlled trials and observational studies assessing biological therapies or ESS in adults with CRSwNP. The primary outcomes were nasal polyp score (NPS), nasal congestion score, Sinonasal Outcome Test (SNOT-22), and adverse events. Omalizumab showed significant improvements in NPS, nasal congestion score, and SNOT-22 scores compared to placebo, with sustained effects in an open-label extension study. Mepolizumab significantly reduced SNOT-22 scores, improved lung function, and decreased blood eosinophil counts and systemic corticosteroid use in patients with severe eosinophilic asthma and CRSwNP. Benralizumab improved NPS and nasal blockage scores compared to placebo, with effects varying by comorbidities and baseline characteristics. ESS with medical therapy showed better SNOT-22 scores than medical therapy alone, though not reaching the minimal clinically important difference. Biological therapies and ESS were well tolerated, with adverse events comparable to those of the placebo. This review demonstrates the effectiveness of biological therapies and ESS in managing CRSwNP, particularly in severe cases of the disease. Further research is needed to evaluate the long-term efficacy, safety, and cost-effectiveness of these interventions in CRSwNP management.

Keywords:

Chronic Rhinosinusitis with Nasal Polyps Omalizumab Mepolizumab Benralizumab Endoscopic Sinus Surgery

References

  1. Bachert, C.; Bhattacharyya, N.; Desrosiers, M.; Khan, A.H. Burden of Disease in Chronic Rhinosinusitis with Nasal Polyps. J. Asthma Allergy 2021, 14, 127–134.
  2. Lou, H.; Zhang, N.; Bachert, C.; Zhang, L. Highlights of eosinophilic chronic rhinosinusitis with nasal polyps in definition, prognosis, and advancement. Int. Forum Allergy Rhinol. 2018, 8, 1218–1225.
  3. Hopkins, C. Chronic Rhinosinusitis with Nasal Polyps. N. Engl. J. Med. 2019, 381, 55–63.
  4. Fokkens, W.J.; Mullol, J.; Kennedy, D.; et al. Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): In-depth sinus surgery analysis. Allergy 2023, 78, 812–821.
  5. Dharmarajan, H.; Falade, O.; Lee, S.E.; Wang, E.W. Outcomes of dupilumab treatment versus endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps. Int. Forum Allergy Rhinol. 2022, 12, 986–995.
  6. Palacios-García, J.; Porras-González, C.; Moreno-Luna, R.; et al. Role of Fibroblasts in Chronic Inflammatory Signalling in Chronic Rhinosinusitis with Nasal Polyps-A Systematic Review. J. Clin. Med. 2023, 12, 3280.
  7. Carsuzaa, F.; Béquignon, É.; Dufour, X.; de Bonnecaze, G.; Lecron, J.C.; Favot, L. Cytokine Signature and Involvement in Chronic Rhinosinusitis with Nasal Polyps. Int. J. Mol. Sci. 2021, 23, 417.
  8. Ryu, G.; Kim, D.W. Th2 inflammatory responses in the development of nasal polyps and chronic rhinosinusitis. Curr. Opin. Allergy Clin. Immunol. 2020, 20, 1–8.
  9. Wynne, M.; Atkinson, C.; Schlosser, R.J.; Mulligan, J.K. Contribution of Epithelial Cell Dysfunction to the Pathogenesis of Chronic Rhinosinusitis with Nasal Polyps. Am. J. Rhinol. Allergy 2019, 33, 782–790.
  10. Chiang, S.; Lee, S.E. New Concepts in Barrier Dysfunction in CRSwNP and Emerging Roles of Tezepelumab and Dupilumab. Am. J. Rhinol. Allergy 2023, 37, 193–197.
  11. Zhao, Y.; Chen, J.; Hao, Y.; et al. Predicting the recurrence of chronic rhinosinusitis with nasal polyps using nasal microbiota. Allergy 2022, 77, 540–549.
  12. Ruan, J.W.; Zhao, J.F.; Li, X.L.; et al. Characterizing the Neutrophilic Inflammation in Chronic Rhinosinusitis With Nasal Polyps. Front. Cell Dev. Biol. 2021, 9, 793073.
  13. Hellings, P.W.; Verhoeven, E.; Fokkens, W.J. State-of-the-art overview on biological treatment for CRSwNP. Rhinology 2021, 59, 151–163.
  14. De Corso, E.; Pipolo, C.; Cantone, E.; et al. Survey on Use of Local and Systemic Corticosteroids in the Management of Chronic Rhinosinusitis with Nasal Polyps: Identification of Unmet Clinical Needs. J. Pers. Med. 2022, 12, 897.
  15. Poetker, D.M.; Jakubowski, L.A.; Lal, D.; Hwang, P.H.; Wright, E.D.; Smith, T.L. Oral corticosteroids in the management of adult chronic rhinosinusitis with and without nasal polyps: an evidence-based review with recommendations. Int. Forum Allergy Rhinol. 2013, 3, 104–120.
  16. de Borja Callejas, F.; Martínez-Antón, A.; Picado, C.; et al. Corticosteroid treatment regulates mucosal remodeling in chronic rhinosinusitis with nasal polyps. Laryngoscope 2015, 125, E158–167.
  17. De Corso, E.; Bellocchi, G.; De Benedetto, M.; et al. Biologics for severe uncontrolled chronic rhinosinusitis with nasal polyps: a change management approach. Consensus of the Joint Committee of Italian Society of Otorhinolaryngology on biologics in rhinology. Acta Otorhinolaryngol. Ital. 2022, 42, 1–16.
  18. Galletti, C.; Barbieri, M.A.; Ciodaro, F.; et al. Effectiveness and Safety Profile of Dupilumab in Chronic Rhinosinusitis with Nasal Polyps: Real-Life Data in Tertiary Care. Pharmaceuticals (Basel) 2023, 16, 630.
  19. Domínguez-Sosa, M.S.; Cabrera-Ramírez, M.S.; Marrero-Ramos, M.D.C.; et al. Real-Life Effectiveness of Mepolizumab in Refractory Chronic Rhinosinusitis with Nasal Polyps. Biomedicines 2023, 11, 485.
  20. van der Lans, R.J.L.; Otten, J.J.; Adriaensen, G.F.J.P.M.; et al. Two-year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months. Allergy 2023, 78, 2684–2697.
  21. Han, J.K.; Bachert, C.; Lee, S.E.; et al. Estimating Clinically Meaningful Change of Efficacy Outcomes in Inadequately Controlled Chronic Rhinosinusitis with Nasal Polyposis. Laryngoscope 2022, 132, 265–271.
  22. Wu, Q.; Zhang, Y.; Kong, W.; et al. Which Is the Best Biologic for Nasal Polyps: Dupilumab, Omalizumab, or Mepolizumab? A Network Meta-Analysis. Int Arch Allergy Immunol 2022, 183, 279–288.
  23. Miglani, A.; Soler, Z.M.; Smith, T.L.; et al. A comparative analysis of endoscopic sinus surgery versus biologics for treatment of chronic rhinosinusitis with nasal polyposis. Int Forum Allergy Rhinol 2023, 13, 116–128.
  24. Morse, J.C.; Miller, C.; Senior, B. Management of Chronic Rhinosinusitis with Nasal Polyposis in the Era of Biologics. J Asthma Allergy 2021, 14, 873–882.
  25. Cergan, R.; Berghi, O.N.; Dumitru, M.; et al. Biologics for Chronic Rhinosinusitis-A Modern Option for Therapy. Life (Basel) 2023, 13, 2165.
  26. Agache, I.; Song, Y.; Alonso-Coello, P.; et al. Efficacy and safety of treatment with biologicals for severe chronic rhinosinusitis with nasal polyps: A systematic review for the EAACI guidelines. Allergy 2021, 76, 2337–2353.
  27. Bachert, C.; Han, J.K.; Desrosiers, M.Y.; et al. Efficacy and safety of benralizumab in chronic rhinosinusitis with nasal polyps: A randomized, placebo-controlled trial. J Allergy Clin Immunol 2022, 149, 1309–1317.
  28. Gevaert, P.; Omachi, T.A.; Corren, J.; et al. Efficacy and safety of omalizumab in nasal polyposis: 2 randomized phase 3 trials. J Allergy Clin Immunol 2020, 146, 595–605.
  29. Gevaert, P.; Saenz, R.; Corren, J.; et al. Long-term efficacy and safety of omalizumab for nasal polyposis in an open-label extension study. J Allergy Clin Immunol 2022, 149, 957–965.
  30. Detoraki, A.; Tremante, E.; D'Amato, M.; et al. Mepolizumab improves sino-nasal symptoms and asthma control in severe eosinophilic asthma patients with chronic rhinosinusitis and nasal polyps: a 12-month real-life study. Ther Adv Respir Dis 2021, 15, 17534666211009398.
  31. Lourijsen, E.S.; Reitsma, S.; Vleming, M.; et al. Endoscopic sinus surgery with medical therapy versus medical therapy for chronic rhinosinusitis with nasal polyps: a multicentre, randomised, controlled trial. Lancet Respir Med 2022, 10, 337–346.
  32. Bolk, K.G.; Wise, S.K. Biologic Therapies across Nasal Polyp Subtypes. J Pers Med 2024, 14, 432.
  33. Gothi, D.; Narasimhan, R.; Guleria, R.; Chopra, M.; Gvalani, A.; Hegde, R. Improving patient outcomes: Mepolizumab's impact in IL-5-mediated diseases. Lung India 2025, 42, 231–244.
  34. Lombardi, C.; Comberiati, P.; Ridolo, E.; et al. Anti-IL-5 Pathway Agents in Eosinophilic-Associated Disorders Across the Lifespan. Drugs 2024, 84, 661–684.
  35. Phillips, K.M.; Hoehle, L.P.; Caradonna, D.S.; et al. Intranasal corticosteroids and saline: Usage and adherence in chronic rhinosinusitis patients. Laryngoscope 2020, 130, 852–856.