Nasal polyposis and response to asthma biologics in real-life: insights from the Belgian Severe Asthma Registry.

<bold>Background:</bold> Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a comorbidity of type 2 severe asthma (SA), which might influence response to SA biologics. <bold>Objectives:</bold> Retrospective evaluation of (super-)response in SA patients with (CRSwNP+) and without CRSwNP (CRSwNP-) enrolled in the Belgian Severe Asthma Registry (BSAR) and assessment of patient and disease characteristics associated with CRSwNP. <bold>Methods:</bold> Patient and disease characteristics at enrolment in BSAR were compared between CRSwNP+ and CRSwNP- patients who were not on a biologic. Also, (super-)response to biologics was compared between these two populations. <bold>Results:</bold> Out of 1353 SA patients in the BSAR, 914, of whom 31% CRSwNP+, could be included. At enrolment, CRSwNP+ patients had a higher annual exacerbation rate, a higher number of emergency room visits and higher type 2 markers. Fractional exhaled nitric oxide was identified as the most important independent predictor of CRSwNP presence. In the longitudinal subanalysis of 104 patients, both groups had significant responses to biologics. The only difference in response was observed for FEV1, with a significantly greater mean (±SD) increase in the CRSwNP+ group (15±20% predicted versus 6±17% predicted). Super-response was present in 33/104 (32%) patients, irrespective of CRSwNP status or type of biologic (anti-IgE and anti-IL5(r)). <bold>Conclusions:</bold> In this real-life study, patients with and without NP both had significant reductions in exacerbation rate and improvements of asthma control, and both were able to achieve super-response under treatment with biologics. However, patients with NP showed a greater FEV1 improvement in under treatment with a biologic.