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Peer-reviewedCC BY-NC-ND 4.0International Forum of Allergy & Rhinology

Efficacy and Predictors of Response to Biologic Therapy and Endoscopic Sinus Surgery in Patients With Nasal Polyps: A Systematic Review

  • Arun Chakravorty1,2
  • Matthew E. Lin1
  • Rory Lubner1
  • Jess C. Mace3
  • Jeffrey Suh1
  • Jivianne Lee1
  • Marilene Wang1
  • Sarah Wise4
  • Naweed Chowdhury5
  • Zachary M. Soler6
  • Justin Turner7
  • Timothy L. Smith3
2 more authors
  • Myung Sim8
  • Daniel M. Beswick1
8 affiliations
  1. 1Department of Head and Neck Surgery David Geffen School of Medicine at UCLA Los Angeles California USA
  2. 2UCLA‐Caltech Medical Scientist Training Program Los Angeles California USA
  3. 3Department of Otolaryngology – Head and Neck Surgery Oregon Health & Science University Portland Oregon USA
  4. 4Department of Otolaryngology – Head and Neck Surgery Emory University School of Medicine Atlanta Georgia USA
  5. 5Department of Otolaryngology – Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee USA
  6. 6Department of Otolaryngology – Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
  7. 7Department of Otolaryngology – Head and Neck Surgery University of Alabama at Birmingham Birmingham Alabama USA
  8. 8Division of General Internal Medicine and Health Services Research David Geffen School of Medicine at UCLA Los Angeles California USA
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Abstract

Background: Biologics and endoscopic sinus surgery (ESS) treat refractory chronic rhinosinusitis with nasal polyposis (CRSwNP), but direct comparisons are lacking. We synthesized efficacy and subgroup data across randomized controlled trials (RCTs) of biologics and ESS.

Methods: PubMed was searched through December 2025 for RCTs and subgroup analyses of biologics or ESS for adult CRSwNP. Included were ten Phase‐3 placebo‐controlled biologic RCTs, two pragmatic ESS trials, and one head‐to‐head biologic trial. 22‐Item Sino‐Nasal Outcome Test (SNOT‐22) and nasal polyp score (NPS) effect sizes and subgroup interactions were extracted.

Results: A total of 13 trials (n = 3775) from 21 publications were included. By indirect comparison, tezepelumab and dupilumab produced the largest improvements (tezepelumab: SNOT‐22: −27.4; NPS: −2.1; dupilumab: SNOT‐22: −17 to −21; NPS: −1.7 to −2.1), while mepolizumab and omalizumab showed intermediate effects (SNOT‐22: −10.6 to −16.5); benralizumab improved NPS but not SNOT‐22, and depemokimab showed improvement below clinically discernible differences. ESS effects varied by trial and follow‐up (SNOT‐22: −21.9 at 6 months in MACRO vs. −4.9 at 12 months in PolypESS). Predictors of improvement differed across therapies (blood eosinophil count, NSAID‐exacerbated respiratory disease, and prior ESS for dupilumab; asthma for benralizumab; baseline severity for ESS), while tezepelumab and omalizumab showed consistent efficacy without effect modification.

Conclusions: ESS and biologics provide clinically meaningful benefit. Among biologics, dupilumab and tezepelumab demonstrated the largest effect sizes, though cross‐trial differences in baseline severity, follow‐up, and comparators limit indirect comparisons. Head‐to‐head trials and standardized subgroup analyses are needed to guide treatment selection.

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Cite

BibTeXRIS
BibTeX
@article{chakravorty2026efficacy,
  title = {{Efficacy and Predictors of Response to Biologic Therapy and Endoscopic Sinus Surgery in Patients With Nasal Polyps: A Systematic Review}},
  author = {Arun Chakravorty and Matthew E. Lin and Rory Lubner and Jess C. Mace and Jeffrey Suh and Jivianne Lee and Marilene Wang and Sarah Wise and Naweed Chowdhury and Zachary M. Soler and Justin Turner and Timothy L. Smith and Myung Sim and Daniel M. Beswick},
  journal = {International Forum of Allergy \& Rhinology},
  year = {2026},
  month = sep,
  doi = {10.1002/alr.70264},
  url = {https://doi.org/10.1002/alr.70264},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Efficacy and Predictors of Response to Biologic Therapy and Endoscopic Sinus Surgery in Patients With Nasal Polyps: A Systematic Review
AU  - Arun Chakravorty
AU  - Matthew E. Lin
AU  - Rory Lubner
AU  - Jess C. Mace
AU  - Jeffrey Suh
AU  - Jivianne Lee
AU  - Marilene Wang
AU  - Sarah Wise
AU  - Naweed Chowdhury
AU  - Zachary M. Soler
AU  - Justin Turner
AU  - Timothy L. Smith
AU  - Myung Sim
AU  - Daniel M. Beswick
PY  - 2026
DA  - 2026/09/09
JO  - International Forum of Allergy & Rhinology
DO  - 10.1002/alr.70264
UR  - https://doi.org/10.1002/alr.70264
AB  - Background: Biologics and endoscopic sinus surgery (ESS) treat refractory chronic rhinosinusitis with nasal polyposis (CRSwNP), but direct comparisons are lacking. We synthesized efficacy and subgroup data across randomized controlled trials (RCTs) of biologics and ESS.  Methods: PubMed was searched through December 2025 for RCTs and subgroup analyses of biologics or ESS for adult CRSwNP. Included were ten Phase‐3 placebo‐controlled biologic RCTs, two pragmatic ESS trials, and one head‐to‐head biologic trial. 22‐Item Sino‐Nasal Outcome Test (SNOT‐22) and nasal polyp score (NPS) effect sizes and subgroup interactions were extracted.  Results: A total of 13 trials (n = 3775) from 21 publications were included. By indirect comparison, tezepelumab and dupilumab produced the largest improvements (tezepelumab: SNOT‐22: −27.4; NPS: −2.1; dupilumab: SNOT‐22: −17 to −21; NPS: −1.7 to −2.1), while mepolizumab and omalizumab showed intermediate effects (SNOT‐22: −10.6 to −16.5); benralizumab improved NPS but not SNOT‐22, and depemokimab showed improvement below clinically discernible differences. ESS effects varied by trial and follow‐up (SNOT‐22: −21.9 at 6 months in MACRO vs. −4.9 at 12 months in PolypESS). Predictors of improvement differed across therapies (blood eosinophil count, NSAID‐exacerbated respiratory disease, and prior ESS for dupilumab; asthma for benralizumab; baseline severity for ESS), while tezepelumab and omalizumab showed consistent efficacy without effect modification.  Conclusions: ESS and biologics provide clinically meaningful benefit. Among biologics, dupilumab and tezepelumab demonstrated the largest effect sizes, though cross‐trial differences in baseline severity, follow‐up, and comparators limit indirect comparisons. Head‐to‐head trials and standardized subgroup analyses are needed to guide treatment selection.
SN  - 2042-6976
SN  - 2042-6984
ER  -