Biologics in Chronic Rhinosinusitis: Current and Emerging

Area of Science:

• Immunology
• Otolaryngology
• Allergy

Background:

• Chronic rhinosinusitis (CRS) presents phenotypically as CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP).
• Disease classification is evolving with endotyping based on immune cell activity (Type 1, Type 2, Type 3).
• The Type 2 endotype is frequently studied and linked to asthma, atopy, and severe CRSwNP.

Purpose of the Study:

• To review the current understanding of CRS endotypes.
• To discuss the role of biologic treatments in managing CRSwNP.
• To highlight ongoing research into novel biologics for various CRS endotypes.

Main Methods:

• Literature review of phenotypic and endotypic classifications of CRS.
• Analysis of current biologic therapies approved for CRSwNP.
• Overview of clinical trials investigating biologics in different CRS endotypes.

Main Results:

• Type 2 endotype is a key focus, associated with specific comorbidities and disease severity.
• Omalizumab, dupilumab, and mepolizumab are approved biologics for poorly controlled CRSwNP.
• Numerous biologics are under investigation for Type 2, non-Type 2, and mixed endotypes in both CRSwNP and CRSsNP.

Conclusions:

• Endotyping provides a more precise approach to understanding CRS pathophysiology.
• Biologic therapies are transforming the management of severe CRS, especially CRSwNP.
• Future research on biologics across diverse CRS endotypes will significantly impact clinical practice.