Outcomes of Biologic Switching in Chronic Rhinosinusitis With Nasal Polyps

Objective(s) Biologic therapies have expanded treatment options for chronic rhinosinusitis with nasal polyps (CRSwNP), but many patients have inadequate response to their initial biologic and requiring switching. Outcomes after switching, particularly patient-reported measures, remain poorly characterized. We aimed to identify predictors and outcomes of biologic switching in adults with CRSwNP. Methods We retrospectively reviewed adults initiating biologics for CRSwNP between 2009 and 2025 at a tertiary center. Demographic, clinical, radiographic, histopathologic, and Sinonasal Outcome Test-22 (SNOT-22) data were collected. Predictors and outcomes of biologic change were analyzed. Results Among 400 patients, 70 (18%) switched biologics after a mean of 38 months. All patients were diagnosed with CRSwNP, which was the primary indication in 61%. Baseline demographics were comparable between groups. Switching was more common with omalizumab (39%) and mepolizumab (40%) than dupilumab (5%) ( P < .01). Most from omalizumab or mepolizumab transitioned to dupilumab for inadequate CRSwNP control (42% and 50%), whereas dupilumab was typically discontinued due to adverse effects (39%). Compared with nonswitchers, switchers more often exhibited radiologic air-fluid levels ( P < .01), asthma ( P < .01), aspirin-exacerbated respiratory disease ( P = .01), and chronic obstructive pulmonary disease ( P = .04). Baseline SNOT-22 scores were similar ( P = .20), but higher for switchers at 6 months ( P < .01). After switching, 70.6% of patients improved, with a mean SNOT-22 reduction of 9.4 points ( P = .02), approaching outcomes of nonswitchers. Conclusion Patients who switch biologics for CRSwNP typically transition to dupilumab due to inadequate symptom control. Biologic switching appears to be an effective strategy for refractory CRSwNP, leading to outcomes comparable to those who respond to initial therapy, despite greater baseline severity.