Outcomes of Biologic Switching in Chronic Rhinosinusitis With Nasal Polyps
Beverly J. Fu, Itzel Jimenez, Michael T. Chang, Zara M. Patel, Jayakar V. Nayak, Peter H. Hwang, Noel AyoubObjective(s)
Biologic therapies have expanded treatment options for chronic rhinosinusitis with nasal polyps (CRSwNP), but many patients have inadequate response to their initial biologic and requiring switching. Outcomes after switching, particularly patient-reported measures, remain poorly characterized. We aimed to identify predictors and outcomes of biologic switching in adults with CRSwNP.
Methods
We retrospectively reviewed adults initiating biologics for CRSwNP between 2009 and 2025 at a tertiary center. Demographic, clinical, radiographic, histopathologic, and Sinonasal Outcome Test-22 (SNOT-22) data were collected. Predictors and outcomes of biologic change were analyzed.
Results
Among 400 patients, 70 (18%) switched biologics after a mean of 38 months. All patients were diagnosed with CRSwNP, which was the primary indication in 61%. Baseline demographics were comparable between groups. Switching was more common with omalizumab (39%) and mepolizumab (40%) than dupilumab (5%) (
Conclusion
Patients who switch biologics for CRSwNP typically transition to dupilumab due to inadequate symptom control. Biologic switching appears to be an effective strategy for refractory CRSwNP, leading to outcomes comparable to those who respond to initial therapy, despite greater baseline severity.