Long-Term Real-World Outcomes and Insights of Biologic Therapies in Chronic Rhinosinusitis with Nasal Polyps
Reut Book, Anna Lazutkin, Ron Eliashar
Abstract
Chronic rhinosinusitis with nasal polyps is a Type 2 inflammatory disease associated with a significant burden on quality of life. While biological therapies have shown efficacy in randomized controlled trials, data on long-term real-world outcomes remain limited. This retrospective cohort study evaluated the clinical efficacy, safety, and treatment dynamics of biologics, particularly anti-IL-4 (dupilumab), over a five-year period at a tertiary medical center. Fifty-two patients with CRSwNP meeting the EPOS/EUFOREA eligibility criteria were included. Clinical parameters, including nasal polyp score, SNOT-22, and olfactory function, were assessed across follow-up intervals. Anti-IL-4 therapy demonstrated the most consistent and sustained improvements in all clinical parameters, with a significant proportion of patients maintaining response beyond 36 months. A subset of patients underwent interval extension of dupilumab injections without loss of efficacy. Subdomain analysis of the SNOT-22 questionnaire revealed improvements predominantly in nasal and emotional domains. Treatment response, assessed according to the EUFOREA criteria, favored anti-IL-4 over anti-IL-5 and anti-IgE. Side effects were infrequent and mostly mild. These findings support the durable effectiveness of biologics in real-world CRSwNP management and suggest that tapering down the injection intervals may be a feasible strategy for selected patients. Further studies are needed to refine treatment response definitions and optimize patient-specific therapeutic approaches.