Biologic therapy in type 2 CRSwNP: from immunopathology to clinical management

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disorder in which type 2 (T2) inflammation represents the predominant endotype, characterized by eosinophilic infiltration and activation of IL-4, IL-5, and IL-13 pathways. Patients with T2-CRSwNP frequently present with asthma, NSAID-exacerbated respiratory disease, and a high risk of recurrence. Conventional management based on intranasal or systemic corticosteroids and endoscopic sinus surgery may relieve symptoms but often fails to achieve sustained disease control in patients with persistent T2 inflammation.

This review summarizes the immunopathology and risk stratification of T2-CRSwNP and discusses current evidence and practical considerations for biologic therapy within a structured clinical decision framework.

Biologic therapies targeting IL-4Rα, IL-5/IL-5R, IgE, and TSLP have demonstrated efficacy in reducing polyp burden, improving symptoms, and decreasing systemic corticosteroid exposure. However, in the absence of robust head-to-head comparisons, optimal patient selection and defining sustainable long-term maintenance strategies remain clinical challenges. Integrating inflammatory profiles, disease burden, and structured follow-up may support individualized treatment and sustained disease control.