Biologics and Their Role in Chronic Rhinosinusitis
Introduction
Chronic rhinosinusitis (CRS) is long-lasting inflammation of the nose and sinuses. Symptoms such as a blocked nose, nasal discharge, facial pressure and reduced sense of smell can continue for 12 weeks or longer. Some people with CRS also develop nasal polyps soft, non-cancerous swellings inside the nose and sinuses.
Many people improve with saline rinses and corticosteroid nasal sprays. Some need additional medicines or endoscopic sinus surgery. However, a smaller group has severe nasal polyps that keep returning or continue to cause major symptoms despite these treatments. This is where biologic therapy may be considered.[2,8,9]
What is a biologic?
A biologic is a medicine designed to block a very specific part of the immune response. The biologics used for nasal polyps are monoclonal antibodies laboratory-made antibodies that recognize particular inflammatory signals in the body.
This makes them different from corticosteroids. Steroids reduce inflammation broadly, while biologics are designed to interrupt selected pathways that may be driving the disease. They do not simply “boost” or “switch off” the whole immune system.[1,9]
Why can biologics help with nasal polyps?
Many people with CRSwNP have a pattern called type 2 inflammation. In simple terms, the immune system becomes overactive in a particular way and releases chemical signals that keep inflammation going. Important signals include interleukin-4 (IL-4), interleukin-5 (IL-5), interleukin-13 (IL-13) and immunoglobulin E (IgE).[1]
These signals can encourage eosinophils and other immune cells to build up in the nasal lining, increase mucus production, worsen swelling and contribute to polyp growth. Type 2 inflammation also helps explain why severe nasal polyps often occur alongside asthma or aspirin/NSAID-exacerbated respiratory disease.[1,2]
Which biologics are being used or studied?
Different biologics target different parts of the inflammatory pathway. The table below keeps the science simple while showing what each treatment is designed to do. Availability and approved indications vary between countries and can change over time.
Biologic | Main target | Summary | What research has shown |
Dupilumab | IL-4 / IL-13 pathway | Blocks a shared receptor used by IL-4 and IL-13, two major type 2 inflammatory signals. | Large trials found smaller polyps, less congestion, better smell and quality of life, and less need for systemic steroids or surgery.[3] |
Omalizumab | IgE | Binds IgE, reducing an important trigger of allergic and type 2 inflammation. | Phase 3 trials found improvements in polyp size, congestion, smell and quality of life.[4] |
Mepolizumab | IL-5 | Blocks IL-5, a signal that helps eosinophils grow and survive. | The SYNAPSE trial found reduced polyp burden and nasal obstruction and a lower need for further surgery in severe recurrent disease.[5] |
Tezepelumab* | TSLP | Blocks an upstream “alarm” signal released by airway lining cells, affecting several inflammatory pathways. | The WAYPOINT trial found major improvements in polyps, congestion, smell and quality of life, with less rescue surgery and systemic steroid use.[6] |
Depemokimab* | IL-5 | A long-acting IL-5 antibody developed to suppress eosinophilic inflammation with infrequent dosing. | The ANCHOR trials found statistically significant improvements in polyp and nasal-obstruction scores.[7] |
Who might be considered for a biologic?
Biologics are generally not the first treatment offered for CRS. Specialist guidance focuses on people with severe, uncontrolled CRSwNP, especially when standard medical treatment and often sinus surgery has not provided lasting control.[2]
A specialist may look at the whole picture, including:
Nasal polyps that remain severe or return after treatment.
Major loss of smell, persistent blockage or a large effect on daily quality of life.
Repeated need for oral or injectable corticosteroids, or a reason these medicines should be avoided.
Coexisting asthma or another type 2 inflammatory condition.
Evidence of type 2 inflammation, such as eosinophilic disease. No single blood test can perfectly predict who will respond.
What benefits can people expect?
Across randomized trials and systematic reviews, biologics have improved several things that matter to patients: nasal blockage, polyp size, sense of smell and disease-related quality of life. Some treatments also reduce the need for systemic corticosteroids or another sinus operation.[3-8]
The response is not identical for everyone. Some people improve substantially, while others have only a partial response or little benefit. For that reason, treatment is reviewed over time rather than automatically continued forever.[2]
Do biologics replace sinus surgery?
Not necessarily. Surgery and biologics tackle the problem in different ways. Endoscopic sinus surgery physically opens blocked sinus pathways and removes obstructing inflammatory tissue. Biologics work on the immune signals helping drive inflammation and polyp regrowth.
For some people, surgery remains the most appropriate next step. For others with severe recurrent disease, a biologic may help reduce the need for repeated surgery. In some cases, both approaches can be part of the long-term treatment plan.[2,9]
Are biologics safe?
In major CRSwNP trials, biologics were generally well tolerated. Possible side effects depend on the medicine, but injection-site reactions, headache and upper-respiratory symptoms are among those reported. More specific effects can occur with individual drugs, so the safety discussion should be tailored to the treatment being considered.[3-7]
Biologics are prescription medicines and should be selected and monitored by a clinician familiar with severe CRS, allergy, asthma and biologic therapy. Pregnancy, other medical conditions, previous reactions and current medicines may also affect the decision.
Why this matters: CRS treatment is becoming more personalized
Biologics represent a change in how severe nasal polyp disease can be treated. Instead of relying only on broad anti-inflammatory therapy or repeatedly removing polyps, clinicians can sometimes target a pathway that is contributing to the inflammation itself.
The challenge now is choosing the right treatment for the right person. Researchers are studying biomarkers, long-term treatment strategies and direct comparisons between biologics so that treatment can become more individualized.[9,10]
Key takeaway
Biologics have created an important additional option for people with severe, uncontrolled chronic rhinosinusitis with nasal polyps. They can reduce polyp burden, improve breathing and smell, and improve quality of life but they are not needed for every person with CRS and they do not make standard treatments irrelevant. The best approach depends on the individual disease pattern, previous treatment, other health conditions and response over time.
References
1. Bachert C, Hicks A, Gane S, et al. The interleukin-4/interleukin-13 pathway in type 2 inflammation in chronic rhinosinusitis with nasal polyps. Front Immunol. 2024;15:1356298. doi:10.3389/fimmu.2024.1356298. PMID: 38690264.
2. Fokkens WJ, Viskens AS, Backer V, et al. EPOS/EUFOREA update on indication and evaluation of biologics in chronic rhinosinusitis with nasal polyps 2023. Rhinology. 2023;61(3):194-202. doi:10.4193/Rhin22.489. PMID: 36999780.
3. Bachert C, Han JK, Desrosiers M, et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and SINUS-52): two randomised phase 3 trials. Lancet. 2019;394(10209):1638-1650. doi:10.1016/S0140-6736(19)31881-1. PMID: 31543428.
4. Gevaert P, Omachi TA, Corren J, et al. Efficacy and safety of omalizumab in nasal polyposis: 2 randomized phase 3 trials. J Allergy Clin Immunol. 2020;146(3):595-605. doi:10.1016/j.jaci.2020.05.032. PMID: 32524991.
5. Han JK, Bachert C, Fokkens W, et al. Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med. 2021;9(10):1141-1153. doi:10.1016/S2213-2600(21)00097-7. PMID: 33872587.
6. Lipworth BJ, Han JK, Desrosiers M, et al. Tezepelumab in adults with severe chronic rhinosinusitis with nasal polyps. N Engl J Med. 2025;392(12):1178-1188. doi:10.1056/NEJMoa2414482. PMID: 40106374.
7. Gevaert P, Desrosiers M, Cornet M, et al. Efficacy and safety of twice per year depemokimab in chronic rhinosinusitis with nasal polyps (ANCHOR-1 and ANCHOR-2): phase 3 randomised trials. Lancet. 2025;405(10482):911-926. doi:10.1016/S0140-6736(25)00197-7. PMID: 40037388.
8. Kariyawasam HH, Chandrasekharan DP, Jacques T, et al. Biologic treatment for severe chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis. Rhinology. 2023;61(2):98-107. doi:10.4193/Rhin22.412. PMID: 37023247.
9. Kratchmarov R, Dharia T, Buchheit K. Clinical efficacy and mechanisms of biologics for chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2025;155(5):1401-1410. doi:10.1016/j.jaci.2025.03.011. PMID: 40132672.
10. Comparative Efficacy of Seven Biologics for Chronic Rhinosinusitis With Nasal Polyps: A Network Meta-Analysis. Allergy. 2026. doi:10.1111/all.70352. PMID: 41999554.
Image: UCB Canada Inc. “Biologic treatment” [Illustration]. UCBCares Canada. (n.d.). Retrieved August 28, 2026, from UCBCares – Biologic Treatments for Inflammatory Arthritis
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