Global Airways: A Danish nationwide real-life registry of biologic therapy for chronic rhinosinusitis with nasal polyps

Vibeke Backer^1,2*Kasper Aanæs^1,2Bent Ivan Larsen^3,4Christiane Haase^1,2Anne-Sophie Homøe^1,2Jens Tidemandsen^1,2Therese Ovesen^5,6Adnan Madzak^5,6Grethe Samuelsen^2,7Jonas Hjelm Andersen^4,8Lars Christian Meyer⁹Kristian Bruun Petersen^10,6Thorbjørn Hermanrud^3,4Lars Peter Schousboe^4,9Christian Korsgaard Pedersen^1,2Kjeld Hansen¹¹Søren Pauli^12,13Mads Vrelits Filtenborg^12,13Bibi Lange^14,4Preben Homøe^3,4Christian Von Buchwald^1,2Anette Kjeldsen^14,4

• ¹Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
• ²Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
• ³Department of Oto-rhino-laryngology, and maxillofacial surgery; Zeeland University Hospital, Køge, Denmark
• ⁴Department of Clinical Medicine and Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
• ⁵Department of Oto-rhino-laryngology, Head and Neck Surgery; Gødstrup Hospital, Herning, Denmark
• ⁶Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
• ⁷Department of Oto-rhino-laryngology, Head and Neck Surgery; Nordsjaellands Hospital, Hilleroed, Denmark
• ⁸Department of Oto-rhino-laryngology, Head and Neck Surgery; Esbjerg Grindsted, Esbjerg, Denmark
• ⁹Department of Oto-rhino-laryngology, Head and Neck Surgery; Lillebaelt Hospital, Vejle, Denmark
• ¹⁰Department of Oto-rhino-laryngology, Head and Neck Surgery; Aarhus University Hospital, Skejby, Denmark
• ¹¹Center for Clinical Research and Prevention, Frederiksberg Hospital, Copenhagen, Denmark
• ¹²Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
• ¹³Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
• ¹⁴Department of Otorhinolaryngology, Head & Neck Surgery, and Audiology, Odense University Hospital, Odense, Denmark

Background The relationship between chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and type 2 inflammation has led to the use of biologic treatment for uncontrolled cases. As biologic treatment remains a relatively new approach for CRSwNP, systematic assessment and collection of high-quality, real-world data are crucial. This study established the national Global Airways registry to collect longitudinal data over a period of 12 months for patients with CRSwNP treated with biological therapies according to criteria established by the Danish Health Authority. Methods All participating sites conducted systematic assessments of patients with CRSwNP referred for initiation of biologic treatment. Clinical and patient-reported outcome data were collected at baseline and after 6 and 12 months of treatment and were entered in real-time into the Global Airways registry. Comparisons were performed between patients eligible or not eligible for biologic therapy and between pre- and post-treatment timepoints. Results A total of 513 patients were enrolled between November 2022 and December 2024, with 310 receiving treatments with biologics (mepolizumab or dupilumab). Mean (standard deviation [SD]) age in the treatment group was 49.7 (14) years and 66% were male. The median number of previous endoscopic sinus surgeries was 2 (range 1–16). Baseline mean (SD) scores were as follows: Nasal Polyp Score (NPS) 4.8 (1.7); Sinonasal Outcome Test (SNOT)-22 68.7 (18.7); Visual Analog Scale (VAS) CRS 84.1 (16); and Sniffin’ Sticks-16 (SST-16) score 4.8 (3). Asthma was present in 204 (66%) patients, with a mean (SD) Asthma Control Questionnaire (ACQ)-5 score of 2.1 (1.5). Among patients with available data at both 6 and 12 months (n=160), mean SNOT-22 scores improved from 68 to 29 and 24, NPS from 5.1 to 3.0 and 2.4, SST-16 from 4.7 to 9.2 and 10.0, and ACQ-5 from 2.3 to 1.0 and 0.8 (all p<0.001). Conclusions The Global Airways registry was an effective working tool that ensured collection of important real-world data when moving from surgery to biologics. Furthermore, the registry demonstrated the sustained effectiveness of biologic therapy in patients with refractory CRSwNP and provided a robust foundation for defining CRS phenotypes and advancing targeted treatment strategies.