Considerations for the Use of Biologics in Chronic Rhinosinusitis With Nasal Polyps

Background: Interventions such as steroids, endoscopic sinus surgery (ESS), biologics, or a combination of these are available for the treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP). However, despite evidence supporting the efficacy of each approach, factors such as timing, cost, side effects, and patient preference need to be considered. The objective of this work was to provide a comparison between current biologics and considerations for each intervention when developing a treatment plan. Methods: Recent studies are referenced in a detailed description of current and developing biologics to compare U.S. Food and Drug Administration (FDA) indications, mechanism of actions, notable side effects, dosage, and cost. Considerations for timing of treatment and duration of treatment when analyzing the utility of ESS, biologics, or a combination of both are highlighted. Results: Currently, 3 biologics are FDA-approved for the treatment of inadequately-controlled CRSwNP and 2 biologics demonstrate promise as potential agents. The overall trend in literature suggests that the combination of ESS to relieve polyps and improve medication delivery and biologics to facilitate anti-inflammatory effects is clinically impactful. Conclusion: Evidence to date aligns with current recommendations that biologics are a promising maintenance option for CRSwNP patients who have failed both medical management and complete ESS.