Efficacy of biologic agents in patients with comorbid asthma and chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis of randomised controlled trials

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Abstract
Background: Multiple biologics targeting type 2 inflammation have been evaluated for the treatment of severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) separately. Objective: To evaluate the efficacy and safety of biologics in patients with comorbid asthma and CRSwNP. Methods: A systematic review of randomised controlled trials (RCTs) from Medline, Embase, Web of Science and Scopus (up to 31 October 2025) was conducted. Random-effects meta-analysis assessed efficacy and safety outcomes. Results: 16 studies involving 3598 patients were included in the meta-analysis. Overall, biologics reduced asthma exacerbations by 73% (rate ratio 0.27, 95% CI 0.21–0.34), increased forced expiratory volume in 1 s by 0.21 L (95% CI 0.11–0.30), improved asthma control questionnaire score by −0.70 points (95% CI −0.83–−0.56) and asthma quality of life questionnaire score by 0.71 points (95% CI 0.49–0.93). Regarding sino-nasal outcomes, the sino-nasal outcome test 22 (SNOT-22) score was reduced by 15.15 points (95% CI −19.64–−10.66), the nasal polyp score by 1.39 points (95% CI −1.88–−0.89), the Lund–Mackay computed tomography score by 6.64 points (95% CI −8.88–−4.40) and the nasal congestion/obstruction score by 0.84 points (95% CI −1.13–−0.54). Heterogeneity across biologic classes varied by outcome, ranging from low to substantial. Overall, biologics exhibited a favourable safety profile. Conclusions: Biologics significantly reduced asthma exacerbations, improved lung function, asthma control and quality of life, and alleviated sino-nasal outcomes in patients with comorbid asthma and CRSwNP, with an acceptable safety profile.

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