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Biologics for chronic rhinosinusitis with nasal polyps: from downstream cytokine blockade to upstream epithelial

Farah Dayana Zahedi1, Baharudin Abdullah2, Pongsakorn Tantilipikorn3

  • 1Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur.

Current Opinion in Allergy and Clinical Immunology
|April 8, 2026
PubMed
Abstract

Insights

New biologic therapies offer personalized treatment for chronic rhinosinusitis with nasal polyps (CRSwNP). Upstream biologics target multiple pathways, improving outcomes for complex cases and advancing CRSwNP management.

Area of Science:

  • Immunology
  • Otolaryngology
  • Pharmacology

Background:

  • Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex inflammatory condition often resistant to standard treatments.
  • Understanding CRSwNP immunopathophysiology has spurred the development of targeted biologic therapies.
  • Personalized medicine approaches are crucial for managing this heterogeneous disease.

Purpose of the Study:

  • To review current downstream biologic therapies for CRSwNP.
  • To discuss emerging upstream biologic therapies targeting epithelial-derived cytokines.
  • To highlight the role of endotype-driven treatment selection in CRSwNP management.

Main Methods:

  • Literature review of current and emerging biologic therapies for CRSwNP.
  • Analysis of immunopathophysiological mechanisms driving CRSwNP.
  • Focus on endotype-specific treatment strategies.

Main Results:

  • Downstream biologics targeting type 2 inflammation mediators (IgE, IL-4, IL-5, IL-13) show efficacy in specific CRSwNP patients.
  • Overlapping inflammatory endotypes can limit treatment response.
  • Upstream biologics offer a broader approach by modulating multiple inflammatory pathways, addressing therapeutic gaps.
  • Long-acting formulations enhance treatment convenience and adherence.

Conclusions:

  • Biologic therapies are revolutionizing CRSwNP management towards personalized, mechanism-based treatments.
  • Upstream-targeted biologics represent a significant advancement, especially for refractory or mixed-endotype CRSwNP.
  • Future research should prioritize biomarker-guided therapy and evaluation of long-term outcomes.
Keywords:
alarminsbiologic therapieschronic rhinosinusitisinflammationnasal polyps

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