Prof. Dr. Ahmet Özdoğan
ENT — General

Biologics in CRS with Nasal Polyps

Three EMA/FDA-approved biologics exist for CRSwNP: dupilumab (anti-IL-4Rα, 2019), mepolizumab (anti-IL-5, 2021) and omalizumab (anti-IgE, 2020); all reduce polyp burden, restore olfaction and lower systemic steroid requirement.

In the general ENT glossary, Biologics in CRS with Nasal Polyps links the patient's wording with the examination questions that matter. Three EMA/FDA-approved biologics exist for CRSwNP: dupilumab (anti-IL-4Rα, 2019), mepolizumab (anti-IL-5, 2021) and omalizumab (anti-IgE, 2020); all reduce polyp burden, restore olfaction and lower systemic steroid requirement. Duration, side pattern, recurrence, comorbidity and prior treatment response all shape how the dictionary entry is interpreted. this topic assessment brings nasal-sinus symptoms, this term throat-tonsil context, the finding upper-airway impact and this entry sleep links into one ENT frame. The page prepares a safer consultation agenda without replacing personal assessment. For the clinical point, the existing summary aims to connect the reported complaint with examination findings: Dupilumab is an anti-IL-4Rα monoclonal antibody blocking IL-4 and IL-13 signalling, indicated for both CRSwNP and asthma. The topic is therefore read with clinical context, not as a one-line definition.

During the dictionary entry examination, the clinician first clarifies what the patient experiences and then checks how well objective findings match it. Daily impact, warning signs and older reports are read together. this topic review may combine ENT examination, the clinical point endoscopic assessment, the dictionary entry oral cavity-oropharynx inspection and this topic audiological testing when useful. this term decisions record fever, the finding pain-bleeding pattern, this entry hearing or nasal blockage, the clinical point sleep impact and the dictionary entry infection recurrence separately. In this topic, the clinical aim is to prove the finding that explains the complaint and separate similar-looking conditions: Eligibility criteria: inadequate response to intranasal corticosteroids plus prior FESS or surgical contraindication. Tests are requested when they help make that distinction. Diagnostic steps should improve decision quality instead of repeating tests by habit.

Care steps for this term move from reversible causes toward persistent structural problems. Conservative options are discussed first when safe, with procedures considered only when the finding justifies them. the dictionary entry planning discusses medical treatment, this topic allergy control, this term endoscopic procedures, the finding adenoid-tonsil strategy or this entry airway surgery by indication. Management of the clinical point is individualized according to symptom duration, examination findings, functional impact, patient expectations, prior treatment response and imaging or laboratory results when needed. Benefit has to be weighed against follow-up burden.

The the dictionary entry follow-up plan depends on treatment type, risk level and pace of recovery. this topic follow-up compares pain, this term nasal openness, the finding sleep quality, this topic hearing impact and this term infection recurrence over time. Safe communication about the finding helps patients notice risky symptoms early without increasing anxiety and supports adherence to follow-up advice. New bleeding, rapid worsening or category-specific warning signs are documented separately from routine timing.

Writing questions about this entry before the appointment helps the patient discuss diagnostic possibilities, treatment limits, review timing and safety warnings more clearly.

In short notes associated findings organizes the consultation start.

During clinical discussion associated findings organizes the consultation start.

For the first assessment associated findings organizes the consultation start.

Before the visit patient expectations organizes the consultation start.

Diagnosis

Biologic candidate identification: bilateral CRSwNP plus inadequate response to intranasal corticosteroids plus prior FESS or surgical contraindication. Dupilumab: blood eosinophilia ≥150/μL or total IgE ≥100 IU/mL (Type 2 biomarker). Lund-Kennedy polyp score ≥5/8 bilateral; Lund-Mackay CT ≥12/24. Baseline SNOT-22 score; olfactory baseline assessment with UPSIT. AERD aspirin sensitivity is a strong predictor of polyp recurrence and biologic response.

Treatment

Dupilumab 300 mg SC every 2 weeks (self-administered). Mepolizumab 100 mg SC monthly. Omalizumab dosed by body weight/IgE nomogram SC every 2–4 weeks. Intranasal corticosteroid is continued throughout all biologic therapy. Efficacy assessment with endoscopy plus SNOT-22 plus UPSIT at 16 weeks. Therapy is discontinued for <10% improvement in polyp score and no clinical benefit.

Outcomes and Follow-up

Dupilumab SINUS-52 trial at 52 weeks: 50% polyp score reduction, 60% olfactory recovery, 19-point SNOT-22 improvement. Mepolizumab: 40% polyp reduction. Omalizumab: particularly effective in AFRS/AERD. All reduce systemic corticosteroid dependency. Long-term outcomes ≥1 year show maintained benefits. Symptom return is expected when treatment is stopped; treatment continuity is mandatory.

When to Seek Care

Bilateral nasal polyps persisting after FESS plus nasal steroid treatment, complete anosmia, systemic corticosteroid requirement ≥2 times per year, or comorbid asthma with CRSwNP are situations warranting referral to an ENT or allergist for biologic therapy evaluation.

Frequently asked questions

What is Biologics in CRS with Nasal Polyps?
Three EMA/FDA-approved biologics exist for CRSwNP: dupilumab (anti-IL-4Rα, 2019), mepolizumab (anti-IL-5, 2021) and omalizumab (anti-IgE, 2020); all reduce polyp burden, restore olfaction and lower systemic steroid requirement. In the general ENT glossary, Biologics in CRS with Nasal Polyps links the patient's wording with the examination questions that matter.
When is Biologics in CRS with Nasal Polyps clinically important?
During the dictionary entry examination, the clinician first clarifies what the patient experiences and then checks how well objective findings match it. It is assessed together with examination, endoscopy or imaging in nasal, throat, sinus and upper-airway complaints.
When is ENT assessment relevant for Biologics in CRS with Nasal Polyps?
ENT assessment becomes relevant if symptoms last more than a few weeks, become one-sided or progressive, or are accompanied by breathing, swallowing, voice, hearing or neck-mass findings.
What information helps assessment of Biologics in CRS with Nasal Polyps?
It is useful to note when symptoms started, which side is affected, previous operations or treatments, current medication, imaging and test reports, and the effect on daily life. It is assessed together with examination, endoscopy or imaging in nasal, throat, sinus and upper-airway complaints.

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References

This glossary entry is for informational purposes only and does not constitute medical advice. Consult a qualified specialist for diagnosis and treatment.

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