Biologics Adoption in CRSwNP and the Associated Decline in Endoscopic Sinus Surgery: A Longitudinal Claims Database Study.

BACKGROUND

Biologic treatments were introduced for chronic rhinosinusitis with nasal polyps (CRSwNP) in 2019. Treatment algorithms for medically refractory CRSwNP remain open, with patients choosing among surgery, biologics, or both. Real-world utilization of surgery and biologics remains incompletely characterized.

OBJECTIVE

The aim of the study is to evaluate temporal trends in endoscopic sinus surgery (ESS) and biologic utilization in relation to 2019 Food and Drug Administration approval of biologics for CRSwNP.

METHODS

Retrospective study of CRSwNP ESS and biologic prescription rates, patient demographics, and comorbidities within the Merative MarketScan Research database (2016-2024). Quarterly and annual trends were evaluated by regression and interrupted time series analyses.

RESULTS

A total of 59,953 CRSwNP patients were included. Annual ESS rates declined, whereas biologic prescriptions increased markedly from 2016 to 2024. Dupilumab dominated among biologic alternatives. Interrupted time series analysis demonstrated a sharp decline in ESS rates with the 2019 introduction of biologics for CRSwNP, whereas biologic use grew continuously across 2016-2024 with a large increase in 2019-2020. Combination ESS and biologic treatment is growing but remains relatively infrequent. Patients receiving biologics were older and suffered from type 2 inflammatory comorbidities, such as asthma and allergic rhinitis (p<0.001 for both).

CONCLUSION

In CRSwNP, biologic treatment has increased significantly in recent years, particularly in older patients or those with type 2 inflammatory comorbidities. Overall ESS utilization in CRSwNP has declined, and combination ESS and biologics are an emerging phenomenon. These figures reveal the extent of evolution in CRSwNP treatment induced by targeted medical therapies in real-world practice and serve as a foundation for healthcare utilization discussions.