CHRONIC RHINOSINUSTITIS WITH NASAL POLYPS: THE ROLE OF BIOLOGICALS IN MODERN MANAGEMENT OF THE DISEASE

Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory disease of the upper airways, characterized by nasal obstruction, rhinorrhea, facial pain, and loss of smell, often associated with recurrence after conventional treatment. Topical and systemic corticosteroids and functional endoscopic sinus surgery remain the main therapeutic options; however, many patients experience relapse, require multiple corticosteroid cycles, and continue to face significant impairment in quality of life. In this context, biological therapies have emerged as an effective alternative by targeting specific pathways of type 2 inflammation. Clinical trials and real-world studies have demonstrated that dupilumab, mepolizumab, and omalizumab significantly reduce nasal polyp scores, improve SNOT-22 and olfactory function, and decrease the use of systemic corticosteroids and the need for revision surgery, with a favorable safety profile. Despite these advances, important gaps remain, including the lack of head-to-head comparisons between biologics, heterogeneity in outcome measures, and the absence of validated biomarkers to guide individualized treatment. These limitations highlight the need for further research to strengthen the role of biologics as a key component of precision medicine in CRSwNP.