CRSwNP in the biologics era: evaluating patient-reported quality of life outcomes

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a prevalent type 2 inflammatory disorder that substantially impairs patient quality of life (QoL) through cardinal symptoms of nasal obstruction, olfactory dysfunction, and sleep disturbance, further compounded by frequent comorbidities including asthma and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (NERD). While conventional therapies with intranasal corticosteroids, systemic corticosteroids, and endoscopic sinus surgery remain foundational, their limitations in achieving durable disease control have prompted the emergence of biologic agents targeting key type 2 inflammatory pathways. This narrative review synthesizes evidence from a targeted literature search including randomized controlled trials and complementary real-world studies to evaluate the impact of biologic therapies on patient-reported QoL outcomes in severe CRSwNP. Biologic agents targeting key mediators of type 2 inflammation have consistently demonstrated clinically meaningful improvements in disease-specific QoL, as measured by the Sinonasal Outcome Test-22 (SNOT-22), across nasal, sleep, olfactory, and emotional domains, with consistent benefits regardless of comorbidities or prior surgery. Real-world evidence corroborates trial findings, demonstrating sustained QoL benefits and reduced dependence on systemic corticosteroids and revision surgery. The integration of patient-reported outcome measures into therapeutic decision-making bridges the gap between objective clinical metrics and lived disease burden, informing patient-centered care models. Biologic therapies have redefined success in CRSwNP management by consistently delivering multidimensional, durable improvements in patient-reported QoL, head-to-head comparisons and optimized treatment sequencing warrant further research.