Efficacy and Predictors of Response to Biologic Therapy and Endoscopic Sinus Surgery in Patients With Nasal Polyps: A Systematic Review.
Arun Chakravorty, Matthew E Lin, Rory Lubner et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review compared efficacy and response predictors for biologics and endoscopic sinus surgery (ESS) in adults with chronic rhinosinusitis with nasal polyps, synthesizing randomized trials and subgroup analyses. Across 13 trials involving 3,775 participants, indirect comparisons found the largest improvements with tezepelumab (SNOT-22: -27.4; nasal polyp score: -2.1) and dupilumab (SNOT-22: -17 to -21; nasal polyp score: -1.7 to -2.1). ESS outcomes varied by trial and follow-up. The authors note that differences between trials limit indirect comparisons and call for head-to-head studies and standardized subgroup analyses.
Key findings
- Tezepelumab had SNOT-22 and nasal polyp score effect sizes of -27.4 and -2.1, respectively.
- Dupilumab had SNOT-22 effect sizes of -17 to -21 and nasal polyp score effect sizes of -1.7 to -2.1.
- ESS SNOT-22 effects varied: -21.9 at 6 months in MACRO versus -4.9 at 12 months in PolypESS.
- Response predictors varied by therapy; tezepelumab and omalizumab showed efficacy without effect modification.
Why it matters
The review brings together trial evidence on symptom and polyp outcomes for two treatment approaches used in refractory disease. Its findings suggest that benefits and potential response predictors differ across therapies, while variation in trial populations, follow-up, and comparators makes ranking treatments uncertain. This distinction is important when interpreting comparative effect estimates and considering how well trial results apply to individual treatment decisions.
What to keep in mind
Comparisons between treatments were indirect, and differences in baseline severity, follow-up, and comparators limit interpretation. The authors also identify a need for head-to-head trials and standardized subgroup analyses.