Efficacy and Predictors of Response to Biologic Therapy and Endoscopic Sinus Surgery in Patients With Nasal Polyps: A Systematic Review.

What was studied

This review gathered trials in adults with nasal polyps that were hard to treat. It looked at biologic drugs and at sinus surgery done through the nose. The team searched PubMed up to December 2025. They found 13 trials with 3775 people, from 21 reports. Drugs and surgery were mainly compared across trials, not within one trial. The main tests were a 22-item symptom survey and a polyp size score.

What they found

Tezepelumab and dupilumab gave the largest gains in symptoms and polyp size. Mepolizumab and omalizumab gave gains in the middle range. Benralizumab shrank polyps but did not ease symptom scores. Depemokimab gains were too small for people to notice. Surgery results changed from trial to trial. One surgery trial showed big symptom gains at 6 months. Another showed smaller gains at 12 months. The signs of who did well were not the same for each option. For dupilumab, these were blood eosinophil levels and NSAID-linked breathing disease. Past sinus surgery also mattered for dupilumab. Asthma mattered for benralizumab. For surgery, how bad things were at the start mattered. Tezepelumab and omalizumab worked in a steady way across groups.

What it means for patients

The authors say surgery and biologic drugs both give real, useful help. Among the drugs, dupilumab and tezepelumab showed the largest effects. The authors say more trials are needed to help choose a treatment.

Why it is not certain yet

Only one trial put drugs side by side. Other drug results were compared across separate trials. These trials differed in how sick people were at the start. They also differed in follow-up length and in what each drug was tested against. Group checks were not done the same way in each trial. A review can only be as good as the studies in it.

Source

Efficacy and Predictors of Response to Biologic Therapy and Endoscopic Sinus Surgery in Patients With Nasal Polyps: A Systematic Review.

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