Strategic Selection of Biologic Therapies in CRSwNP Management

Chronic rhinosinusitis with nasal polyps (CRSwNP) often manifests as persistent inflammation in nasal passages and sinuses, leading to complications like polyp formation, nasal congestion, reduced olfaction, and facial discomfort. For those unresponsive to conventional therapies such as corticosteroids or surgical interventions, biologic therapies offer a promising alternative, tailored to address the underlying pathophysiology of the disease.

The landscape of biologic treatments for CRSwNP is continuously evolving with scientific advancements and regulatory approvals. These therapies, such as dupilumab, omalizumab, mepolizumab, reslizumab, and benralizumab, primarily target inflammatory pathways associated with polyp formation and CRSwNP symptoms. Dupilumab, notably, has received FDA approval for CRSwNP, showing significant reductions in polyp size and symptom improvement in clinical trials.

The selection of an appropriate biologic therapy hinges on comprehensive patient assessments, including disease severity, coexisting conditions, and prior treatment responses. Here, personalization of treatment is paramount, considering each patient’s unique clinical profile and the specific characteristics of each biologic:

• Dupilumab appears effective in severe cases as evidenced by robust clinical data.
• Omalizumab shows potential in polyps, particularly for patients with comorbid asthma.
• Mepolizumab and reslizumab, targeting the IL-5 pathway, could be beneficial, awaiting further clinical validation.
• Benralizumab has emerged from small-scale studies as a possible contender in CRSwNP management.

The intricacies of choosing the correct biologic therapy encompass not only medical efficacy but also practical considerations such as availability, regulatory status, and economic aspects, given the typically high costs associated with biologic treatments.

This field remains dynamic and progressively data-driven as ongoing trials and emerging biologics will continue to refine and expand the therapeutic options available for CRSwNP. Continued research and real-world efficacy studies are essential to optimize treatment algorithms and truly personalize therapy, thereby enhancing patient outcomes in this challenging clinical area.

We welcome contributions that provide deeper insights into:
• Comparative effectiveness of current biologic therapies for CRSwNP.
• Long-term outcomes and safety profiles of biologics in clinical practice.
• Impact of biologic therapies on patient quality of life and disease management.
• Economic evaluations to guide treatment selections in diverse healthcare settings.

As this specialty progresses, alignment with the latest clinical trials and regulatory updates will be crucial for healthcare providers to deliver optimal, evidence-based care for patients suffering from CRSwNP.

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Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Community Case Study
• Editorial
• FAIR² Data
• FAIR² DATA Direct Submission
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Review
• Study Protocol
• Systematic Review

Keywords: Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), Biologic therapies, Dupilumab, Omalizumab, Mepolizumab, Reslizumab, Benralizumab, Inflammatory pathways, Biologic treatment efficacy, Personalized medicine, Biologics, CRS with nasal polyps, Persistent CRS, eCRS

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