For decades, management of chronic rhinosinusitis with nasal polyps (CRSwNP) has centered on a predictable pattern: topical corticosteroids, short courses of systemic steroids during exacerbations, and eventual endoscopic sinus surgery.1 However, high recurrence rates and incomplete responses to standard interventions have underscored the need for more personalized treatment strategies.2
A growing body of research has clarified the immunologic underpinnings of CRSwNP, with type 2 inflammation playing a key role in the pathogenesis of most cases.3 This has opened the door for precision medicine in routine otolaryngologic practice. Biomarker profiles, including blood eosinophils, total IgE, and tissue cytokine expression, are being explored to identify patients most likely to respond to targeted biologic therapies.4
Dupilumab, which inhibits interleukin (IL)-4 and IL-13 signaling, has been shown in multiple phase 3 trials to reduce polyp burden and nasal obstruction, while also improving olfactory function and quality of life.3 Its effectiveness in patients with comorbid asthma or NSAID-exacerbated respiratory disease supports its role as a systemic modifier of type 2 inflammatory disease.5
While IL-4/IL-13 blockade is currently the most established approach, investigational therapies that target IL-5/IL-5R and its receptor are emerging. New biologics aimed at upstream regulators like thymic stromal lymphopoietin (TSLP) and IL-33 could potentially benefit broader subsets of patients or those with partial response to existing agents.5
As clinical guidelines evolve, integrating endotyping and biomarker assessment into routine care can help specialists select the most appropriate treatment pathway.2 While still controversial as to which type of surgery is best in managing distinct CRSwNP endotypes, this personalized approach aims to reduce reliance on systemic corticosteroids and minimize surgical recurrence.2 Given the complex interplay of inflammatory cells and comorbid conditions, identifying endotypes, rather than relying solely on phenotypes or histologic subtypes, can better guide treatment selection, predict therapeutic response, and address the heterogeneity inherent in CRSwNP.6
The incorporation of biologics into CRSwNP care reflects a broader trend toward precision medicine across chronic inflammatory airway diseases.2,5 Staying informed about emerging targets and the supporting evidence is critical for tailoring therapy, improving outcomes, and redefining standards of care.
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