Biologics and Surgery in Chronic Rhinosinusitis With Nasal Polyps: A Comparative Outcomes Analysis

Area of Science:

• Otolaryngology
• Immunology
• Medical Therapeutics

Background:

• Chronic rhinosinusitis with nasal polyps (CRSwNP) significantly impacts quality of life, causing nasal obstruction, facial pressure, and altered smell.
• Endoscopic sinus surgery (ESS) is a common treatment, but nasal polyp recurrence necessitates alternative or adjunctive therapies.
• Biologic therapies targeting type-2 inflammation demonstrate efficacy in improving sinonasal symptoms for CRSwNP patients.

Purpose of the Study:

• To conduct a meta-analysis comparing the longitudinal efficacy of endoscopic sinus surgery (ESS) versus biologic therapies in managing chronic rhinosinusitis with nasal polyps (CRSwNP).
• To evaluate standardized outcome measures, including symptom scores, nasal polyp burden, and olfactory function, for both treatment modalities.

Main Methods:

• A systematic literature search was performed across major electronic databases (MEDLINE, EMBASE, Cochrane Library, Web of Science, ClinicalTrials.gov) up to August 2024.
• A random-effects meta-analysis synthesized data from 27 studies, focusing on changes in the Sino-Nasal Outcome Test-22 (SNOT-22) scores.
• Secondary analyses examined changes in nasal polyp score (NPS) and olfactory function, with heterogeneity assessed using I² statistics.

Main Results:

• Both ESS and biologic therapies led to significant improvements in SNOT-22 scores at 6 and 12 months, with no statistically significant difference between the two groups.
• While both treatments improved outcomes from baseline, biologic therapies showed a trend towards superior improvement in olfactory function at 6 months compared to ESS.
• Analysis of nasal polyp scores and olfactory function was limited by the small number of studies available for secondary outcomes.

Conclusions:

• Significant heterogeneity exists in patient selection, outcome measurement methods, and longitudinal data collection across studies comparing ESS and biologics for CRSwNP.
• Future research should prioritize standardized data collection and consistent follow-up protocols to enable robust comparative meta-analyses.
• Both ESS and biologic therapies are effective in managing CRSwNP, but further high-quality comparative studies are needed to refine treatment strategies.