Is Switching Biologics in CRSwNP Promising? Real-World Evidence for Clinical Outcome Measures in Comparison

Objective: Biologics are well established in treating severe chronic rhinosinusitis with nasal polyps (CRSwNP). Most patients benefit from the first chosen biologic agent, in a few cases switching biologics can be a further therapeutic strategy. Methods: In this monocentric retrospective study, patients with CRSwNP and biologic therapy were compared with respect to Sino-Nasal Outcome Test-22 (SNOT-22) score, bilateral nasal polyp score (NPS), and change in biologic agent as primary variables. Statistical analysis was performed using independent sample t -tests or Welch’s t -tests for continuous variables and Pearson’s chi-squared test for categorical data. Results: A total of 48 patients with CRSwNP who received biologic therapy between 2020 and 2024 were included in this study. During the course of treatment, 10 patients (20.4%) required a switch to a different biologic agent. A significant reduction in both the SNOT-22 score and NPS was observed in patients regardless of whether a biologic switch occurred, following a minimum post-treatment observation period of 6 months. No significant differences in clinical outcomes were found between patients who switched biologics and those who continued with their initial agent. Conclusions: Most patients switched from anti-immunoglobulin E or anti-IL-5 treatment to anti-IL-4/-IL-13, with good improvement in therapy control. Notably, symptom control after switching biologics does not differ significantly from that achieved in patients who remained on their initial biologic therapy.