Targeted biologics for chronic rhinosinusitis with nasal polyps: efficacy and safety comparison of eight monoclonal antibodies via network meta-analysis

BACKGROUND: Biologics targeting key type 2 inflammatory mediators (e.g., IL-4Rα, IgE, IL-5, TSLP) represent a novel therapeutic approach for chronic rhinosinusitis with nasal polyps (CRSwNP). This network meta-analysis (NMA) aimed to compare the efficacy and safety of eight monoclonal antibodies for CRSwNP. METHODOLOGY: We systematically searched PubMed, Embase, Web of Science, CENTRAL Cochrane, and MEDLINE for randomized controlled trials (RCTs) comparing monoclonal antibodies with placebo CRSwNP. A Bayesian Network meta-analysis (NMA) was performed using the R gemtc package. RESULTS: Sixteen RCTs (n=2,034) evaluating eight monoclonal antibodies were included. All biologics significantly reduced Nasal Polyp Score (NPS); stapokibart (anti-IL-4Rα) ranked first. Both dupilumab and stapokibart improved the University of Pennsylvania Smell Identification Test (UPSIT) score, indicating a recovery of olfactory function. Dupilumab led in improving Sino-Nasal Outcome Test-22 (SNOT-22) scores, whereas stapokibart was most effective in relieving nasal congestion score (NCS). The risk of adverse events was comparable to placebo across all biologics, with GR1802 exhibiting the most favorable safety. CONCLUSIONS: All evaluated biological agents demonstrated efficacy superior to placebo, with IL-4 receptor alpha inhibitors showing the largest and most consistent benefits. All treatments exhibited favorable safety profiles, supporting their use for long-term management of CRSwNP.