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H.J. Aljubran - M.R. Alabdulaal - L.A. Aldhaif - D.M. Motabagani - R.M. Alhussain - Z.S. AlWusaybie - F.O Aldhafeeri - A. Almomen

DOI: 10.4193/Rhin25.623

BACKGROUND: Biological therapy is a newer line of treatment that has been utilized in practice for patients with chronic rhinosinusitis with nasal polyps, showing excellent results. However, some patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) do not respond to this therapy. Hence, this study aims to evaluate the efficacy and safety of biological switching in these patients.
METHODOLOGY: Using the Web of Science, Cochrane, MEDLINE, and Embase databases, we analyzed studies involving biological switching in CRSwNP patients published up to June 2025. The studies were extracted, and data were pooled for meta-analysis.
RESULTS: Of 3,367 studies identified, eight studies (involving 470 patients) were included in the systematic review, four of which were included in the meta-analysis. The results showed that the most common reason for switching was insufficient CRS symptom control (59.7%), followed by undesirable side effects (10.8%). The findings demonstrated dramatic effects of biological switching in terms of the SNOT-22 score, with a mean improvement of 71.4%. In addition, studies that switched patients to dupilumab
showed significant improvement after switching in both SNOT-22 and nasal polyp scores. Overall, the success rate of biological switching ranged from 59.6% to 100%, with an average success rate of 79.2%.
CONCLUSIONS: This review demonstrated the effect of biological switching as an option for patients with refractory CRSwNP or those experiencing biological side effects. These findings highlight a new therapeutic alternative that can serve as a fundamental choice when managing CRSwNP patients.

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