Comparative efficacy of biologics for uncontrolled asthma patients with chronic rhinosinusitis or nasal polyps: a systematic review and network meta-analysis

Akinari Tsukada; Nozomu Tsurumaki; Junko Terada-Hirashima; Jin Takasaki; Naoki Nishimura; Hiroshi Nokihara; Shinyu Izumi; Masayuki Hojo

doi:10.1186/s12890-025-03911-7

Comparative efficacy of biologics for uncontrolled asthma patients with chronic rhinosinusitis or nasal polyps: a systematic review and network meta-analysis

BMC Pulm Med. 2025 Sep 30;25(1):432. doi: 10.1186/s12890-025-03911-7.

Authors

Akinari Tsukada¹, Nozomu Tsurumaki², Junko Terada-Hirashima², Jin Takasaki², Naoki Nishimura², Hiroshi Nokihara², Shinyu Izumi², Masayuki Hojo²

Affiliations

¹ Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan. atsukada@hosp.ncgm.go.jp.
² Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan.

Abstract

Background: Asthma patients with comorbid chronic rhinosinusitis or nasal polyps (CRS/NP) often experience poor asthma control. However, the comparative efficacies of biological therapies in this subgroup remain unclear.

Methods: A comprehensive search of multiple databases was conducted to identify randomized controlled trials (RCTs) on biological therapies targeting uncontrolled asthma that included CRS/NP data. The outcomes of interest were annual asthma exacerbation rate (AER), pre-bronchodilator forced expiratory volume in one second (pre-BD FEV1), asthma control questionnaire (ACQ) scores, and sinonasal outcome test (SNOT-22) scores. Pairwise meta-analyses were performed based on the presence or absence of CRS/NPs. Subsequently, random-effects network meta-analyses were conducted to perform indirect comparisons of the individual biological therapies.

Results: Eleven eligible RCTs evaluating tezepelumab, dupilumab, mepolizumab, and benralizumab were identified. Omalizumab and reslizumab were excluded because subgroup data were not available. Pairwise meta-analyses demonstrated significantly greater improvement effects of biological therapies on all outcomes in patients with CRS/NP than in those without CRS/NP (p < 0.01). In the network meta-analyses, for CRS/NP patients, tezepelumab showed the most pronounced reduction in AER (rate ratio 0.17; 95% confidence interval [CI] 0.09, 0.29), while benralizumab (mean difference [MD] 0.30 L; 95% CI 0.19, 0.40) exhibited the greatest improvement in pre-BD FEV1. Tezepelumab demonstrated the most substantial improvement in the ACQ scores (MD -0.80; 95% CI -1.25, -0.35), whereas mepolizumab (MD -11.80; 95% CI -19.75, -3.85) was associated with the greatest improvement in the SNOT-22 scores.

Conclusions: In the management of asthma with CRS/NP, it is crucial to select biological therapies that consider specific improvements in individual outcomes.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12890-025-03911-7.

Keywords: Asthma; Biologics; Chronic rhinosinusitis; Nasal polyps; Network meta-analysis.