Medication adherence to biologics for chronic rhinosinusitis with nasal polyps: a Chinese Real-World Survey

Background: Biologic therapies (omalizumab and dupilumab) for chronic rhinosinusitis with nasal polyps (CRSwNP) are well-established in Western populations, but their real-world usage and adherence in China remain poorly characterized. Objective: To characterize CRSwNP patients receiving biologic therapy in Beijing and evaluate the real-world treatment adherence to omalizumab and dupilumab. Methods: We conducted a retrospective analysis of electronic medical records from 403 CRSwNP patients treated with omalizumab or dupilumab in Beijing Tongren Hospital from January 2019 to December 2024 to characterize their demographic and clinical profiles. To evaluate real-world adherence patterns of biologics, we analyzed a subset of 288 CRSwNP patients who received ≥2 consecutive biologic treatments within 6 months. Results: Of 29,594 CRSwNP outpatients, only 403 (1.4%) received biologic therapy. Omalizumab was the predominant initial choice (84.9%), followed by dupilumab (9.9%), with 5.2% of patients eventually switching between agents. Importantly, omalizumab- and dupilumab-treated patients exhibited different comorbidity patterns. Omalizumab-treated patients showed significantly higher adherence than dupilumab-treated patients (median proportion of days covered [PDC]: 60.6% vs. 38.9%). Using median PDC (56%) and persistence (147 days) to categorize patients into 4 adherence subgroups (I–IV), most omalizumab-treated patients fell into the high-adherence group (group I), whereas dupilumab-treated patients were primarily in the low-adherence group (group III). Within the omalizumab group, group I had significantly lower out-of-pocket costs than group III, suggesting a potential inverse relationship between treatment costs and adherence rates. Conclusion: Biologic therapies for CRSwNP remain underutilized in Beijing. Our findings show superior treatment adherence with omalizumab compared with dupilumab. To improve outcomes for severe CRSwNP patients, healthcare reforms are required to prioritize enhancing adherence through cost reduction and financial support.