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Responders to biologics in severe uncontrolled chronic rhinosinusitis with nasal polyps: a multicentric observational real-life study.

N Saroul, O Malard, G Lefevre, A Coste, V Escabasse, G de Bonnecaze, R Jankowski, C Rumeau, F Carsuzaa, B Verillaud, E Bequignon, C Vandersteen, V Favier, J-P Lecanu, J-F Papon, C Daveau, G Mortuaire, L de Gabory, J Michel, L Castillo

Journal: Rhinology 2025;63(1):22-31

PMID: 39660730

Full Text on International Rhinologic Society View on PubMed

Abstract

BACKGROUND

Clinical trials have demonstrated the effectiveness of biologics in treating chronic rhinosinusitis with nasal polyps (CRSwNP). However, real-world evidence regarding patient outcomes and predictors of clinical response remains limited.

METHODOLOGY

In this multicentric 18-month follow-up study, 326 adult patients who initiated biologic therapy for severe uncontrolled CRSwNP were included. Patient characteristics, including clinical and inflammatory markers, and comorbidities were collected at baseline and at 3, 6, 12, and 18 months of follow-up. We examined success rates based on current guidelines and identified potential factors associated to clinical response at 6 months.

RESULTS

We observed a significant decrease of Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score (interquartile range) of 60.5 (47-74) at baseline to 26.0 (11-41) at 3 months. A significant decrease of nasal symptoms and endoscopic nasal polyp score was observed at 3 months. After 6 months of biologic treatment, 59% of patients were classified as excellent responders according to the EUFOREA-EPOS 2023 criteria. Multivariate analysis revealed a suggestive association between baseline eosinophil blood count, type of biologic and an excellent response at 6 months.

CONCLUSIONS

This real-world study confirms the effectiveness of biologics as an add-on therapy in patients with severe uncontrolled CRSwNP. Biologics lead to rapid and sustained improvement in clinical symptoms. A significant proportion of patients exhibit an excellent response, with no need for systemic corticosteroids.

Address: Otorhinolaryngology, Head and neck Department - Huriez Hospital, CHU Lille, Lille, France; Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France.; Otorhinolaryngology, Head and neck Department, Creteil, France. CNRS EMR 7000, Creteil, France. INSERM, IMRB, Univ Paris Est Creteil, Creteil, France.; Otorhinolaryngology, Head and neck Department, Croix Rousse Hospital, Lyon, France.; Otorhinolaryngology, Head and neck Department, AP-HP, Bicetre Hospital, Le Kremlin-Bicetre, France. Universite Paris-Saclay, Faculte de Medecine, Le Kremlin-Bicetre, France. CNRS EMR 7000, Creteil, France. INSERM, IMRB, Univ Paris Est Creteil, Creteil, France.; Otorhinolaryngology, Head and neck Department, Institut Arthur Vernes, Paris, France.; Otorhinolaryngology, Head and neck Department, Gui de Chauliac Hospital, CHU Montpellier, France. Research-team ICAR, Laboratory of Computer Science, Robotics and Microelectronics of Montpellier (LIRMM), Univ. Montpellier, French National Centre for Scientific Research (CNRS), Montpellier, France.; Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, France.; Head and Neck University Institute, ENT Department, CHU, Nice, France. Universite; Cote d'Azur, Nice, France.; Head and Neck University Institute, ENT Department, CHU, Nice, France. Universite Cote d'Azur, Nice, France.; Otolaryngology Head and Neck Surgery Department, CHU Clermont-Ferrand France, Clermont-Ferrand, France. Human Nutrition Unit, INRAE, Auvergne Human Nutrition Research Center, Clermont Auvergne University, CHU de Clermont-Ferrand France, INRAE, UNH, Clermont-Ferrand, France.; Otorhinolaryngology and Skull Base Center, AP-HP, Lariboisiere Hospital, Paris, France. Universite Paris Cite 75010 Paris, France. INSERM U1141 NeuroDiderot, Paris, France.; Otorhinolarynology and audiophonology department, CHU Poitiers, Poitiers, France. Laboratoire Inflammation Tissus Epitheliaux et Cytokines (LITEC), UR15560, Universitede Poitiers, Poitiers, France.; Otorhinolaryngology, Head and neck Department, Universite de Lorraine, CHRU Nancy, Nancy, France; Universite de Lorraine, DevAH, Nancy, France.; Otorhinolaryngology, Head and neck Department, universite; de Lorraine, CHRU Nancy, Nancy, France; Universite de Lorraine, DevAH, Nancy, France.; Aix Marseille Univ, APHM, CNRS, IUSTI, La Conception University Hospital, ENT-HNS Department, Marseille, France.; Department of ENT and Head and Neck Surgery, Toulouse University Hospital, Larrey Hospital, Toulouse, France.; Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France; Institute of Immunology, CHU Lille, Lille, France.; Department of Otorhinolaryngology, CHU Hotel Dieu, Nantes, France.
DOI: 10.4193/Rhin24.284

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MeSH Terms: Humans, Nasal Polyps, Sinusitis, Rhinitis, Chronic Disease, Female, Male, Biological Products, Middle Aged, Adult, Treatment Outcome, Follow-Up Studies, Sino-Nasal Outcome Test, Severity of Illness Index, Aged, Rhinosinusitis
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