D2.168 - Impact of type two inflammation inflamation suppression on polyp burden in patients with nasal polyposis and concomitant asthma a comparative evaluation of biologic therapies

hronic rhinosinusitis with nasal polyps (CRSwNP) frequently coexists with asthma and is driven by type 2 inflammation. Biologic therapies targeting IgE and interleukin-5 pathways have emerged as effective treatment options for severe disease. This study aimed to evaluate the impact of type 2 inflammation suppression on polyp burden and clinical outcomes in patients with CRSwNP and concomitant asthma and to comparatively assess biologic therapies in a real-life setting.

A total of 130 patients with CRSwNP and asthma receiving biologic therapy (omalizumab, mepolizumab, or benralizumab) were retrospectively analyzed. Demographic data, disease duration, atopy status, and treatment duration were recorded. Pre- and post-treatment evaluations included Modified Lund-Mackay (Zinreich) CT score, Sino-Nasal Outcome Test-22 (SNOT-22), peripheral blood eosinophil count and percentage, total IgE levels, eosinophil cationic protein (ECP), and forced expiratory volume in one second (FEV1). Statistical comparisons were performed using the Wilcoxon signed-rank test.

The mean age was 46.1 years and 60.8% were female. After biologic therapy, the Modified Lund-Mackay (Zinreich) score significantly decreased from 36.9 to 28.8 (p<0.001). SNOT-22 scores improved from 69.1 to 49.2. Peripheral eosinophil count decreased from 647/µL to 281/µL (p<0.001), and eosinophil percentage declined from 6.9% to 3.54% (p<0.001). FEV1 improved from 82% to 86% (p=0.002). Total IgE levels showed a significant change (p<0.001), whereas ECP levels did not demonstrate a significant difference (p=0.623). Clinical and radiological improvements were observed across biologic treatments.

Suppression of type 2 inflammation with biologic therapies significantly reduces polyp burden, improves sinonasal symptoms, and enhances asthma-related functional outcomes in patients with CRSwNP and concomitant asthma. These real-life findings support the effectiveness of biologic treatment in severe type 2 inflammatory disease.