Efficacy of different biologics for treating chronic rhinosinusitis with nasal polyps: a network meta-analysis

Currently, there is a debate around the use of biological agents in the treatment of chronic sinusitis with nasal polyps. Therefore, this study's purpose was to assess the effectiveness of various biologics in the treatment of chronic rhinosinusitis with nasal polyps.

A systematic and manual search was conducted for all relevant studies from inception to December 20, 2023. Two independent authors carried out the search, screening, assessment, and data extraction. Network meta-analysis was conducted using STATA 14 software.

Our analysis includes a comprehensive set of 19 studies. These studies compared the efficacy of four distinct biologic treatments. The results of reticulated Meta-analysis showed that Dupilumab (MD = − 1.85, 95% CI: − 2.47, − 1.24), Omalizumab (MD = − 1.30, 95% CI: − 1.90, − 0.70), Benralizumab (MD = − 0.84, 95% CI: − 1.66, − 0.03) and Mepolizumab (MD = − 1.48, 95% CI: − 2.22, − 0.74) were superior to placebo from the nasal polyp score(NPS), Dupilumab (MD = − 12.56, 95% CI: − 22.49,− 2.63) was superior to placebo from the Sino-Nasal Outcome Test-22(SNOT-22)score, and Dupilumab (MD = − 0.84, 95% CI: − 1.08, − 0.59) and Omalizumab (RR = − 0.51, 95% CI: − 0.83, − 0.19) were superior to placebo from the nasal congestion severity(NCS). In terms of cumulative sorting under the surface of the curve (SUCRA) values, Dupilumab was the best performer in the NPS (0.92), SNOT-22 score (0.70), and NCS (0.93); Four different biologics outperformed placebo in the NPS, SNOT-22 score, and NCS.

In patients with CRSwNP, based on the efficacy (NPS, (SNOT-22) score, NCS) and, dupilumab is the most efficacious for CRSwNP.