Surgery and/or biologics in chronic rhinosinusitis with nasal polyps: EUFOREA/EPOS consensus paper

The therapeutic landscape of chronic rhinosinusitis with nasal polyps (CRSwNP) has rapidly evolved over the past 6 years with the arrival of biologics, prompting a re-evaluation of the traditional stepwise management centred on corticosteroids and endoscopic sinus surgery (ESS). Although both ESS and biologics have proven efficacy, the optimal sequence, extent and timing of ESS relative to biologics remains a matter of debate. The international multidisciplinary panel of experts of EUFOREA/EPOS reached consensus on the aims, indications, timing, and therapeutic positioning of ESS, and biologics in CRSwNP. Evidence from pivotal RCTs, real-life studies and recent guidelines was critically reviewed. Consensus statements were drafted and refined through multiple rounds of discussion and voting. This EUFOREA/EPOS report provides key definitions and clinical criteria for ESS and biologics particiin CRSwNP, offering a unified framework for personalized, evidence-based care with the aim to achieve the best outcomes for patients. The expert group agreed that patients with diffuse disease should have at least a primary complete ESS, that concurrent initiation of sinus surgery and biologic therapy is not recommended with current evidence, and the indication for biologic therapy as established by earlier guidelines were enforced. It was emphasized that with the current knowledge on side effects of systemic corticosteroids, their long-term use is no longer accepted especially where biologics are available. By emphasizing complementary and disease-modifying effects of novel care strategies, this initiative aims at optimizing outcomes across the entire airway continuum in line with EPOS/EUFOREA's mission.