Optimizing Biologic Treatment Selection in Chronic Rhinosinusitis with Nasal Polyps: A Network Meta-Analysis of Efficacy and Safety Across 22 RCTs.

Background/

Objectives

Biological therapies have emerged as targeted treatments for chronic rhinosinusitis with nasal polyps (CRSwNP), yet direct comparisons between agents remain limited. This network meta-analysis (NMA) aimed to evaluate and rank the efficacy and safety of biological therapies for CRSwNP in adult patients.

Methods

We conducted a systematic review and NMA of randomized controlled trials (RCTs) assessing biological therapies for CRSwNP. A literature search was conducted through July 2025. Eligible RCTs compared approved or investigational biologics with a placebo and reported clinical, functional, or safety outcomes in adults with CRSwNP. The mean differences (MDs) in the least-squares mean change from baseline were used for continuous outcomes, and odds ratios (ORs) were used for binary outcomes. A frequentist random-effects model was used to estimate pooled effects and treatment rankings. SUCRA values and rank probabilities were derived to determine the relative efficacy and safety.

Results

A total of 22 RCTs (46 reports; 4068 patients) evaluating eight biologics were included. Dupilumab consistently ranked among the top three agents across most efficacy outcomes, including nasal polyp score (NPS), nasal congestion score (NCS), SNOT-22, UPSIT, and endoscopic scores. CM310 and Tezepelumab also demonstrated strong performance in objective and symptom-based outcomes. For responder outcomes, CM310 was ranked best in minimal clinically important differences across multiple domains. PF-06817024 ranked best in minimizing any adverse events and serious adverse events. The placebo ranked worst across nearly all endpoints.

Conclusions

Dupilumab, CM31 0, and Tezepelumab exhibit the most favorable efficacy profiles across multiple CRSwNP domains, while all drugs show a nearly similar safety profile.