Chronic rhinosinusitis with nasal polyps (CRSwNP) is increasingly understood as a systemic inflammatory disease, driven by the release of interleukin (IL)-4, IL-5, and IL-13. Traditional treatments, including intranasal corticosteroids, systemic corticosteroids, and endoscopic sinus surgery, have provided important symptom relief but may fall short of durable, long-term control.1 Relapse is common, and the presence of increased tissue eosinophils is one factor that has been shown to predict recurrence. 2
Biologic therapies are reshaping the treatment landscape by targeting the underlying immunologic mechanisms of CRSwNP. Dupilumab, a monoclonal antibody that regulates the inflammatory response through inhibition of IL-4 and IL-13 signaling, is the first biologic approved by the FDA specifically for patients with inadequately controlled CRSwNP.3 Clinical trials have demonstrated its ability to significantly reduce nasal polyp size, improve nasal obstruction, and restore olfaction.3 These outcomes reflect its unique ability to address the epithelial inflammation and tissue remodeling at the core of the disease process.
Other investigational agents are following this pathway-based approach. Anti–IL-5/anti-IL5R therapies, such as mepolizumab and benralizumab, are being explored in patients with CRSwNP characterized by eosinophilic inflammation, especially when asthma is comorbid.4 Patients with asthma and comorbid CRSwNP typically experience severe symptoms as disease is usually driven by type 2 inflammation.4 Upstream targets like thymic stromal lymphopoietin (TSLP) and IL-33 are under active investigation for patients who may not respond to current agents.4
This therapeutic evolution enables clinicians to move beyond reactive treatment models toward long-term disease modification. Biologic therapy is not intended to replace surgery but to complement it by improving baseline control, delaying the need for surgical intervention, or reducing recurrence after surgery. Providers should now assess for the completeness of functional endoscopic sinus surgery (FESS), and the Amsterdam Classification on Completeness of Endoscopic Sinus Surgery (ACCESS) score has been proven to be effective in this assessment.4,5
As evidence accumulates, the shift toward inflammation-targeted care represents a paradigm change for patients living with severe, recurrent CRSwNP. Otolaryngologists, along with providers specialized in treating chronic rhinosinusitis, will be central to integrating these options into individualized, phenotype-guided treatment strategies.
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