Endotype-driven precision medicine in chronic rhinosinusitis

Introduction: Chronic rhinosinusitis (CRS) is a heterogeneous disease spectrum with variable phenotypes and endotypes that are not well characterized. Conventional treatment options are insufficient; recent research in precision medicine focuses on providing endotype-driven care based on underlying mechanisms.Areas covered: A comprehensive overview of CRS phenotypes and endotypes is provided. Biomarkers have been identified to predict prognosis and guide personalized pharmacotherapy, surgery, and innovative treatments. For CRS with nasal polyps (CRSwNP), type 2-targeting biologics, such as anti-IgE, anti-IL4Rα, and anti-IL5 antibodies, have been explored in clinical trials.Expert opinion: In addition to differences in immunopathogenic mechanisms and responses to medical and surgical interventions, CRS endotypes vary according to geography and ethnicity and their distributions change over time. Endotype-driven integrated care is a promising approach. Our current understanding of type 2 inflammation is well ahead of that of other endotypes. Biomarkers of type 2 inflammation show good predictive ability for corticosteroid responsiveness and disease recurrence. Type 2-targeted treatments are effective for CRSwNP based on clinical trials. The identification of patient subsets and effective biomarkers is important for optimizing biotherapeutic strategies. Further studies should focus on non-type 2 inflammation-targeted treatment approaches and the safety of biologics for routine clinical use.