OBJECTIVES: The objective of this systematic literature review (SLR) and meta-analysis (MA) is to compare the efficacy and quality of life (QoL) outcomes of biologics as an add-on treatment with standard care (SOC) i.e., corticosteroids, to SOC alone in adult patients with chronic rhinosinusitis with nasal polyposis (CRSwNP).

METHODS: Key biomedical databases (Embase and PubMed) including bibliographic searching of published SLR/MA were conducted to identify randomized controlled trials (RCTs) assessing biologics in adult patients with CRSwNP. Two independent reviewers performed screening and data collection, followed by a quality control check by a third reviewer, adhering to PRISMA guidelines. The Cochrane ROB2 tool was used to evaluate the risk of bias of the included RCTs. STATA17.0 software was used to calculate the weighted mean difference (WMD) from the mean change from the baseline score of Nasal polyp score (NPS) and Sino-nasal outcome test score (SNOT-22) from 24 ± 4 weeks and 52 ± 4 weeks of treatment.

RESULTS: Among the 378 screened publications, nine RCTs met the inclusion criteria involving a total of 1,952 patients. All RCTs were conducted globally at multiple centers except two conducted in the US. The various biologics assessed were dupilumab (n=2), mepolizumab (n=2), benralizumab (n=2), and omalizumab (n=3). At 24 ± 4 weeks of treatment, biologics + SOC demonstrated a statistically significant reduction in mean scores on NPS (WMD: -0.97; 95%CI: -1.40, -0.54; p=0.000) and SNOT-22 (WMD: -13.13; 95%CI: -18.05, -8.21; p=0.000) scales compared to SOC. Similar results were observed after 52 ± 4 weeks of treatment with biologics + SOC on NPS (WMD: -1.25; 95%CI: -2.27, -0.22; p=0.017) and SNOT-22 (WMD: -14.31; 95%CI: -21.67; -6.95; p=0.000) scales compared to SOC.

CONCLUSIONS: This SLR-MA demonstrates that adding biologics to SOC significantly enhances efficacy and QoL in CRSwNP patients compared to SOC alone, thus reducing the dependence on systemic corticosteroids.