COMPARATIVE REAL-WORLD EFFECTIVENESS OF BIOLOGICS IN SEVERE ASTHMA: INSIGHTS FROM NASAL POLYP SUBGROUPS

Introduction: Severe asthma (SA) is a complex, heterogeneous condition requiring targeted therapies in patients with uncontrolled disease. The aim of this study was to perform a head-to-head comparison of the effectiveness of biologic therapies in patients with SA and to determine whether their therapeutic response differs between those with coexisting nasal polyps (NP) and those without. Methods: Patients with SA who received omalizumab, mepolizumab or benralizumab for at least six months at our Allergy and Clinical Immunology department between May 2024 and August 2025 were retrospectively reviewed. Demographic data, laboratory results, Asthma Control Test (ACT) and Sinonasal Outcome Test (SNOT-22) scores, were recorded at baseline and after 6 months of treatment. Results: A total of 46 patients with SA received omalizumab (n=12), mepolizumab (n=14), or benralizumab (n=20). Demographic and clinical characteristics, including NP and atopy, were recorded. Biologic therapy led to significant improvements in lung function, symptom control, and asthma exacerbation rates. FEV₁, FVC, and FEV₁/FVC ratios increased, ACT scores rose from 11.5±4.5 to 19.7±3.6, and SNOT-22 scores decreased from 54.9±20.4 to 24.9±16.9 (all p<0.001). Asthma exacerbations declined from 2.82 to 0.1 per year (p<0.001). All three biologics showed comparable benefits. Although benralizumab demonstrated a greater absolute reduction in exacerbations, this finding was driven by higher baseline rates, and percentage reductions were similar across groups. When analyzed by NP status, similar improvements were observed in both NP (+) and NP (–) patients across lung function, ACT, SNOT-22, and exacerbation outcomes. Conclusion: Omalizumab, mepolizumab, and benralizumab provide meaningful clinical and functional benefits in SA, with consistent efficacy regardless of the presence of NP. Further randomized head-to-head trials and extended real-world studies are warranted to better understand potential differences in effectiveness between biologics.