International Rhinologic Society Rhinology 0300-0729 2026 04 16 Biologics for chronic rhinosinusitis with nasal polyps: a real-world prospective cohort study EN M. BlauwblommeDepartment of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium A-S. ViskensKU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, Leuven, Belgium Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium Department of Ear-Nose-Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium E. Bonne Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium E. Borgers Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leuven, Belgium C. Cox Department of Otorhinolaryngology, Jessa Hospital, Hasselt, Belgium G. De Vos Department of Otorhinolaryngology, Head and Neck Surgery, Sint-Lucas Hospital, Ghent, Belgium L. Derycke Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium A-S. EeckelsDepartment of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium S. Halewyck Department of Otorhinolaryngology, University Hospital Brussels, Jette, Belgium V. Hox Department of Otorhinolaryngology, University Hospital Saint-Luc, Brussels, Belgium P. Janssen Laboratory of Experimental Otorhinolaryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium P. JanssenDepartment of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium W. Lemmens Department of Otorhinolaryngology, Hospital Oost-Limburg, Genk, Belgium F. Rogister Department of Otorhinolaryngology, CHU de Liège, Belgium K. Speleman Department of Otorhinolaryngology, General Hospital Sint-Jan Bruges, Bruges, Belgium M. SyssauwDepartment of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium O. VandervekenFaculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium Department of Ear-Nose-Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium E. VandewalleDepartment of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium S. Vanhee Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium B. Verhaeghe Department of Otorhinolaryngology, AZorg Aalst, Belgium A.V. VroegopFaculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium Department of Ear-Nose-Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium T. Van ZeleDepartment of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium P. GevaertDepartment of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium P.W. HellingsUpper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium KULeuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, Leuven, Belgium Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leuven, Belgium Journal Article 3451 10.4193/Rhin26.004 BACKGROUND: Monoclonal antibody therapies targeting type 2 inflammation for chronic rhinosinusitis with nasal polyps (CRSwNP) have shown efficacy in randomized controlled trials (RCTs), however prospective real-world comparative data across all appro-ved biologics remain limited. We aimed to evaluate the real-world effectiveness of omalizumab, mepolizumab, and dupilumab in patients with severe CRSwNP. METHODOLOGY: A prospective, multicentre, real-world phase IV study in Belgium, enrolling 360 patients with severe CRSwNP initiating treatment with omalizumab (n=65), mepolizumab (n=242), or dupilumab (n=53) between March 2022 and April 2025. Clinical data were collected at baseline and after 6 months. The therapeutic response was evaluated based on EUFOREA criteria. RESULTS: After 6 months, nasal polyp score (NPS), olfactory function, and patient-reported outcomes improved across all biologics, with concurrent improvements in asthma control within each treatment group. A good-to-excellent multidomain therapeutic response was achieved in 51% of patients, and treatment continuation beyond 6 months was observed in 74% of omalizumab-, 81% of mepolizumab-, and 92% of dupilumab-treated patients. No severe adverse events were reported. CONCLUSION: In this real-world cohort, the three registered biologics provided significant clinical benefit in severe CRSwNP, with numerically larger improvements observed in patients treated with dupilumab.