Efficacy of biologic agents in patients with comorbid asthma and chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND

Multiple biologics targeting type 2 inflammation have been evaluated for the treatment of severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) separately.

OBJECTIVE

To evaluate the efficacy and safety of biologics in patients with comorbid asthma and CRSwNP.

METHODS

A systematic review of randomised controlled trials (RCTs) from Medline, Embase, Web of Science and Scopus (up to 31 October 2025) was conducted. Random-effects meta-analysis assessed efficacy and safety outcomes.

RESULTS

16 studies involving 3598 patients were included in the meta-analysis. Overall, biologics reduced asthma exacerbations by 73% (rate ratio 0.27, 95% CI 0.21-0.34), increased forced expiratory volume in 1 s by 0.21 L (95% CI 0.11-0.30), improved asthma control questionnaire score by -0.70 points (95% CI -0.83--0.56) and asthma quality of life questionnaire score by 0.71 points (95% CI 0.49-0.93). Regarding sino-nasal outcomes, the sino-nasal outcome test 22 (SNOT-22) score was reduced by 15.15 points (95% CI -19.64--10.66), the nasal polyp score by 1.39 points (95% CI -1.88--0.89), the Lund-Mackay computed tomography score by 6.64 points (95% CI -8.88--4.40) and the nasal congestion/obstruction score by 0.84 points (95% CI -1.13--0.54). Heterogeneity across biologic classes varied by outcome, ranging from low to substantial. Overall, biologics exhibited a favourable safety profile.

CONCLUSIONS

Biologics significantly reduced asthma exacerbations, improved lung function, asthma control and quality of life, and alleviated sino-nasal outcomes in patients with comorbid asthma and CRSwNP, with an acceptable safety profile.