Clinical Effects and Response Time of Biological Drugs in Chronic Rhinosinusitis with Nasal Polyps Patients: Real-life Experience.

Objective: Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a challenging condition often managed with biologic therapies. This study compares the clinical effects and response times of dupilumab, omalizumab, and mepolizumab in Italian patients with severe uncontrolled CRSwNP.

Methods: This bicentric, retrospective study included 33 patients treated at two Italian hospitals between April and December 2023. Inclusion criteria followed EPOS 2020 guidelines, focusing on adults with bilateral polyposis, history of endoscopic sinus surgery, and evidence of type 2 inflammation. Patients self-administered biologics according to AIFA protocols. Outcomes were assessed using SNOT-22 for quality of life, Nasal Polyp Score (NPS) for polyp size, and Sniffin' Sticks-12 for olfactory function at baseline, 4 weeks, 3, 6, and 9 months.

Results: All three treatment groups (dupilumab, omalizumab, mepolizumab) showed significant improvements in SNOT-22 scores from baseline to 9 months, with no significant differences between groups. Dupilumab showed the most rapid and sustained improvement in NPS, with significant reductions observed from 4 weeks onward. Both omalizumab and mepolizumab showed significant NPS reductions by 6 months. Olfactory function improved significantly in the dupilumab group, with a notable decrease in anosmic patients from 64.3% to 28.6% at 9 months. Asthma control, measured by Asthma Control Test (ACT) scores, improved across all groups.

Conclusion: Dupilumab, omalizumab, and mepolizumab significantly improve quality of life and reduce nasal polyp size in CRSwNP patients, with dupilumab showing the fastest response. These findings support the effectiveness of biologics in real-world settings for managing severe CRSwNP.

Level of evidence: 3 Laryngoscope, 2024.