Biologics for eosinophilic chronic rhinosinusitis: advances and emerging frontiers

Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by nasal obstruction, rhinorrhea, postnasal drip, and olfactory dysfunction, all of which significantly impair patients’ quality of life. Eosinophilic chronic rhinosinusitis (ECRS) is often classified as a subset of CRSwNP, with severity determined using criteria established by the JESREC Study. However, severe cases have a recurrence rate exceeding 75% within six years of surgery. For refractory cases that are unresponsive to surgery or oral steroids, the biological agent dupilumab gained insurance approval in 2020, offering new hope for achieving clinical remission. This article reviews the eligibility criteria and treatment evaluation methods for biologics in CRSwNP, as outlined in the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020) and EUFOREA guidelines, while also highlighting the key differences in Japanese clinical practices. Although biologics offer a promising treatment option for refractory cases, challenges related to cost and optimal therapy duration remain unresolved.