What are the biologic treatments for nasal polyps with asthma?

From the Guidelines

Biologic treatments for nasal polyps with asthma include dupilumab, omalizumab, and mepolizumab.

Biologic Treatment Options

• Dupilumab: has been shown to improve both atopic dermatitis and chronic rhinosinusitis with nasal polyps (CRSwNP) 1
• Omalizumab: an anti-IgE therapy, has been studied for the treatment of patients with CRSwNP, with significant improvements in symptom scores and reduction of polyp size on endoscopic examination 1
• Mepolizumab: a blocker of free IL-5, has been evaluated in patients with CRSwNP, with significant improvements in symptom scores, reduction of polyp size, and decrease in blood eosinophil counts 1

Considerations for Biologic Treatment

• Patients with high baseline disease severity may benefit from biologic treatment, while those with low disease burden may prefer to avoid systemic therapy and opt for less-invasive treatments such as intranasal corticosteroids (INCS) 1
• Patients with comorbid diseases and dual indications for a specific biologic may help direct clinicians to choose a specific biologic 1
• Biologics may be preferred over oral corticosteroids in patients with aspirin-exacerbated respiratory disease (AERD) due to the increased risk of harm associated with oral corticosteroids in these patients 1

From the Research

Biologic Treatments for Nasal Polyps with Asthma

• Biologics such as dupilumab, benralizumab, omalizumab, and mepolizumab are used to treat severe asthma with or without chronic rhinosinusitis with nasal polyps (CRSwNP) 2, 3, 4, 5, 6
• These biologics target type 2 inflammation and have been shown to improve nasal polyp size, nasal congestion, and quality of life in patients with CRSwNP 4, 5, 6
• A study found that switching to dupilumab improved sinonasal outcomes in patients with severe asthma and comorbid CRSwNP who had inadequate control of nasal symptoms with previous biologic treatment 2
• Another study found that biologic therapy reduced the need for oral corticosteroids and improved nasal polyp score and sinonasal outcome test in patients with CRSwNP and asthma 3
• A real-world comparison of T2-biologics found that anti-IL4R was superior in improving loss of smell, nasal obstruction, and nasal polyp endoscopic score in patients with severe allergic asthma and nasal polyps 5
• The choice of biologic treatment for patients with severe asthma and nasal polyps is important and difficult to achieve due to the lack of comparative head-to-head studies 6

Types of Biologics Used

• Anti-IgE biologics such as omalizumab 3, 5
• Anti-IL5/5R biologics such as benralizumab and mepolizumab 2, 3, 5
• Anti-IL4R biologics such as dupilumab 2, 5