A study published in the International Forum of Allergy & Rhinology revealed promising benefits of  endoscopic sinus surgery and biologics in patients having chronic rhinosinusitis with nasal polyposis (CRSwNP). Data from a phase-3 biologic study were compared to a prospective, multicenter cohort of CRSwNP patients who had endoscopic sinus surgery. Lund-Kennedy (LK) grading was used to quantify baseline nasal endoscopy in people receiving endoscopic sinus surgery.

The investigation comprised individuals who met the modified inclusion criteria from the Mepolizumab-SYNAPSE, Omalizumab-POLYP-1&2, and Dupilumab-LIBERTY-NP-24&52 trials. When it was practicable, baseline traits and outcome metrics were contrasted between these cohorts at 24 and 52 weeks. Overall, 111 CRSwNP people fulfilled the adjusted inclusion standards. Between the endoscopic sinus surgery and biologic groups, no discernible differences were noted in baseline age, gender, asthma status, aspirin-aggravated respiratory illness status, smell identification, LK-polyp score, or Lund-Mackay computed tomography scores.

Compared to Dupilumab, Endoscopic sinus surgery yielded comparable  22-item Sino-Nasal Outcome Test (SNOT-22) improvements at 24 and 52 weeks. In comparison with Omalizumab, endoscopic sinus surgery provided superior SNOT-22 improvements. When compared to one (of two) Dupilumab trials and both Omalizumab trials, endoscopic sinus surgery considerably outperformed the control group at 24 weeks on SNOT-22. 

At 24 weeks, both Dupilumab and endoscopic sinus surgery elicited similar improvements in the ability to identify smells. Despite similar improvements in smell recognition, endoscopic sinus surgery was linked with considerably lower nasal polyp scores than Dupilumab and Omalizumab. When compared to Dupilumab, endoscopic sinus surgery improved SNOT-22 scores at 52 weeks, although nasal polyp scores remained considerably reduced in the endoscopic sinus surgery group than in the groups treated with Mepolizumab and Dupilumab.