Combined response to biologics in patients with T2 severe asthma and chronic rhinosinusitis with nasal polyps

<bold>Background:</bold> Biologics for T2 severe asthma (SA) are also approved for uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). Real-world studies showed the biologics effectiveness in treatment of CRSwNP in patient with T2 SA, however clinical response for SA and CRSwNP may vary among biologics. <bold>Aim:</bold> To analyse SA and CRSwNP combined response to biologics in a population with SA. <bold>Methods:</bold> A retrospective analysis of data charts was performed on patients with SA treated by omalizumab (OMA), mepolizumab (MEPO), benralizumab (BENRA), dupilumab (DUPI). Super (SR), Complete (CR), partial (PR), and Not Responders (NR) to treatment were defined by improvement in: asthma/CRS exacerbations, oral corticosteroid (OCS) intake, ACT, lung function, NP endoscopic score, Lund Mackay score, SNOT-22 and nasal symptoms, collected at baseline and at the end of follow up. <bold>Results:</bold> A total of 42 data sets were analysed. Mean duration of therapy was 39 ± 24 months. Regarding SA response: 26.4% were PR, 52.4% were CR (of which 4 patients SR), 19% were NR. Among biologics, the rate of PR+CR was: DUPI 100%, OMA 80%, MEPO 79%, BENRA 67%. The rate of NP response was: 28.5% CR (of which 6 patients SR), 33.3% PR, 38.1% NR. Among NR, 15/16 patients showed NP relapse. Overall, 9.5% patients didn’t respond neither for SA nor for NP, 28.6% responded only for SA, whilst 9.5% had isolated NP response. Finally, 52.4% responded satisfactory both for SA and NP, being DUPI the best in combined response (88%) vs MEPO (35.7% p 0.03), OMA (40% p 0.06), BENRA (55.6% p 0.3). <bold>Conclusion:</bold> Biologics are effective in T2 SA and NP but not all patients reached the expected outcomes for both diseases in real world.