Extent of Sinus Surgery Is Associated With Disease Control in Biologic Treated Type 2 Dominant CRS

A greater benefit of biologics is observed after surgery in Type 2 chronic rhinosinusitis with nasal polyps (CRSwNP). However, the extent of surgery remains undefined in many studies. This study evaluated the extent of surgery on disease control in patients receiving biologics for refractory Type 2 dominant CRSwNP.

A cross-sectional study was performed on patients with CRSwNP treated with biologics for ≥ 6 months at a tertiary center. All patients had undergone prior sinus surgery, which included a sphenoethmoidectomy and then extension via Draf I, IIa, IIb, IIc, or III. Disease control was defined as having a SNOT-22 ≤ 30, endoscopic modified Lund-Mackay ≤ 4, and the absence of rescue therapy within 6 months. Comparisons were made across surgical and biologic groups, and logistic regression was used to identify factors associated with disease control.

A total of 159 patients were assessed (age 50.9 ± 12.8 years, 45.3% female). Disease control was achieved in 49.1% of patients. Disease control was greater with extended surgery (Draf III 60.8% [49.7%-70.8%] vs. Draf IIc 68.3% [53.0%-80.4%] vs. Draf IIa 8.7% [2.4%-26.8%] vs. Draf I 0% [0.0%-19.4%]; p < 0.001). The control was similar across biologic types (anti-IL-4αR 63.3% [45.5%-78.1%] vs. anti-IL-5/5R 45.7% [37.3%-54.3%]; p = 0.083). On regression, extended surgery (Draf III + IIc) was associated with disease control (Draf III/IIc vs. Draf IIa/I OR: 110.2 [12.7-14,682.5]) but not biologic type (anti-IL-4αR vs. anti-IL-5/5R OR: 2.2 [0.7-7.2]). However, class switching had already occurred in 15.1% of patients initially treated with anti-IL-5/5R.

Disease control was greatest in CRSwNP patients who had both extended sinus surgery and optimized biologic treatment.