Association Between Biologic Therapy and Reduced Acute Rhinosinusitis Episodes: A Retrospective Database Study

To assess whether biologics (dupilumab, mepolizumab, and omalizumab) used for conditions other than chronic rhinosinusitis with nasal polyps (CRSwNP) reduce the frequency of acute bacterial rhinosinusitis (ABRS) episodes.

This retrospective cohort study utilized the All of Us Research Program database to identify patients treated with dupilumab, mepolizumab, or omalizumab, excluding those with CRSwNP. A control group matched by race, gender, and comorbidities (asthma, allergic rhinitis, atopic dermatitis, smoking status) was created using propensity score matching (1:1 ratio) and K-nearest neighbors. The primary outcome was the frequency of ABRS episodes in biologic-exposed versus control groups, analyzed using χ² tests to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

Out of 2094 subjects, the biologic group had a significantly lower ABRS rate (6%) compared to controls (14%) (OR 0.4349, p < 0.0001). Dupilumab use was associated with the greatest significant reduction in ABRS risk (OR 0.1526, p < 0.001044). Mepolizumab (OR 0.6027, p = 1) and omalizumab (OR 0.7671, p = 0.4133) showed a decrease in ABRS episodes though this finding was not statistically significant.

Dupilumab appears to significantly reduce ABRS episodes in patients without CRSwNP, suggesting a protective effect on sinonasal health even in patients without chronic sinusitis. Further studies are needed to confirm these effects and to evaluate risks associated with long-term biologic use in non-CRSwNP populations.

IIIb/IV.