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Which Is the Best Biologic for Nasal Polyps: An Updated Network Meta-Analysis
Xi Xu1, Jinting Lin2, Minting Luo1
1Department of Otorhinolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Clinical and Translational Allergy
|November 3, 2025
Summary
Dupilumab shows the best efficacy and safety for chronic rhinosinusitis with nasal polyps (CRSwNP). Tezepelumab offers comparable efficacy to omalizumab for nasal polyp score, highlighting treatment options for CRSwNP.
Area of Science:
- Allergy and Immunology
- Otolaryngology
- Pharmacology
Background:
- Comparative efficacy data for biologics in chronic rhinosinusitis with nasal polyps (CRSwNP) are limited.
- Novel agents like tezepelumab require direct comparison to optimize precision management of CRSwNP.
Purpose of the Study:
- To rank the comparative efficacy and safety of dupilumab, tezepelumab, omalizumab, and mepolizumab versus placebo for CRSwNP.
- Utilize network meta-analysis to provide evidence-based rankings for CRSwNP biologic therapies.
Main Methods:
- Network meta-analysis of randomized controlled trials (RCTs) identified via comprehensive database searches (PubMed, Embase, Web of Science, Cochrane Library).
- Primary outcomes included Nasal Polyp Score (NPS) and safety (adverse events); secondary outcomes assessed SNOT-22, UPSIT, and NCS.
- Surface Under the Cumulative Ranking Curve (SUCRA) was used for treatment ranking, with GRADE methodology for evidence certainty.
Main Results:
- Dupilumab demonstrated superior efficacy across NPS, SNOT-22, UPSIT, and NCS, ranking highest (SUCRA ≥ 0.900).
- Tezepelumab showed strong performance, ranking second in NPS (SUCRA: 0.720) and UPSIT (SUCRA: 0.749).
- Omalizumab ranked highest in safety (SUCRA of adverse events: 0.064), with predominantly high certainty of evidence for key comparisons.
Conclusions:
- Dupilumab exhibits the most favorable efficacy and safety profile for CRSwNP management.
- Tezepelumab offers efficacy comparable to omalizumab regarding the Nasal Polyp Score, providing valuable insights for treatment selection.
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