Is Switching Biologics in CRSwNP Promising? Real-World Evidence for Clinical Outcome Measures in Comparison.

OBJECTIVE

Biologics are well established in treating severe chronic rhinosinusitis with nasal polyps (CRSwNP). Most patients benefit from the first chosen biologic agent, in a few cases switching biologics can be a further therapeutic strategy.

METHODS

In this monocentric retrospective study, patients with CRSwNP and biologic therapy were compared with respect to Sino-Nasal Outcome Test-22 (SNOT-22) score, bilateral nasal polyp score (NPS), and change in biologic agent as primary variables. Statistical analysis was performed using independent sample t-tests or Welch's t-tests for continuous variables and Pearson's chi-squared test for categorical data.

RESULTS

A total of 48 patients with CRSwNP who received biologic therapy between 2020 and 2024 were included in this study. During the course of treatment, 10 patients (20.4%) required a switch to a different biologic agent. A significant reduction in both the SNOT-22 score and NPS was observed in patients regardless of whether a biologic switch occurred, following a minimum post-treatment observation period of 6 months. No significant differences in clinical outcomes were found between patients who switched biologics and those who continued with their initial agent.

CONCLUSIONS

Most patients switched from anti-immunoglobulin E or anti-IL-5 treatment to anti-IL-4/-IL-13, with good improvement in therapy control. Notably, symptom control after switching biologics does not differ significantly from that achieved in patients who remained on their initial biologic therapy.