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Simultaneous Dual Type 2 Biologic Therapy Improves Sinonasal Outcomes in Selected Patients With Chronic
Friederike Bärhold1, Jan Hagemann1, Eugenio de Corso2,3
1Center for Rhinology and Allergology, Wiesbaden, Germany.
Allergy
|August 4, 2026
Summary
Dual biologic therapy offers significant symptom improvement for severe chronic rhinosinusitis with nasal polyps (CRSwNP) and type 2 comorbidities. This approach, while effective in complex cases, requires careful patient selection due to unknown long-term safety and high costs.
Area of Science:
- Immunology
- Pulmonology
- Otolaryngology
Background:
- Chronic rhinosinusitis with nasal polyps (CRSwNP) frequently co-occurs with systemic type 2 inflammatory diseases due to shared pathophysiology.
- Dual biologic therapy is rarely used in complex CRSwNP cases with inadequate response to single biologic treatments.
Purpose of the Study:
- To evaluate the current utilization of dual biologic therapy in patients diagnosed with CRSwNP.
- To assess the efficacy and safety of dual biologic therapy for CRSwNP and associated type 2 comorbidities.
Main Methods:
- Retrospective, multicentric study involving adult patients with severe, uncontrolled CRSwNP receiving dual type-2 biologic therapy.
- One biologic agent in the dual therapy was required to be approved for CRSwNP treatment.
- Therapy decisions were individualized following interdisciplinary consultations.
Main Results:
- Thirty-four CRSwNP patients from Germany, the Netherlands, and Italy were included, many with complex medical histories and type 2 comorbidities.
- Dual biologic combinations included dupilumab/mepolizumab, mepolizumab/tezepelumab, benralizumab/dupilumab, dupilumab/omalizumab, and dupilumab/tezepelumab.
- Significant improvements in CRSwNP outcomes (SNOT-22, NPS, Smell, VAS) were observed at 6 months compared to baseline single biologic therapy.
- Four patients experienced adverse reactions, including urticaria, erythema, gastrointestinal symptoms, weight gain, and arthralgia.
Conclusions:
- Dual biologic therapy can be indicated for managing CRSwNP and comorbid type 2 diseases in select, complex cases.
- Long-term efficacy and safety data for dual biologic therapy in CRSwNP are currently unknown.
- This treatment approach should be reserved for carefully selected patients due to potential off-label use and significant costs.
