Targeting Type 2 Inflammation: The Role of Biologics in Chronic Rhinosinusitis with Nasal Polyposis

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Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common, disabling inflammatory airway disease marked by persistent sinonasal symptoms, impaired quality of life, and frequent comorbidities such as asthma and aspirin-exacerbated respiratory disease. Standard treatment relies on intranasal corticosteroids, systemic corticosteroids, and endoscopic sinus surgery; however, recurrence is common, and many patients develop corticosteroid dependence or require repeated surgery, raising concerns about long-term safety and disease control. Advances in understanding CRSwNP immunopathogenesis have identified type 2 (T2) inflammation as a central driver, characterized by eosinophilic infiltration and cytokine signaling mediated by interleukin (IL)-4, IL-5, IL-13, and epithelial alarmins such as thymic stromal lymphopoietin (TSLP), leading to targeted biologic therapies that modulate these pathways. This narrative review summarizes current evidence on biologic agents approved or in advanced clinical development for CRSwNP. Data from pivotal randomized controlled trials and real-world studies show that these biologics reduce nasal polyp size, improve sinonasal symptoms and olfactory function, enhance quality of life, and decrease the need for systemic corticosteroids and revision surgery, with benefits particularly pronounced in patients with coexisting asthma. Overall, biologic therapy represents a paradigm shift in managing severe CRSwNP, enabling personalized treatment while highlighting the need for long-term data, head-to-head comparisons, and cost-effectiveness analyses.

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