Different Response Criteria and Response Rates for Biologic Therapy in Patients With Chronic Rhinosinusitis With Nasal Polyps: A Systematic Review and Meta-Analysis.

Abstract

Objective: Different criteria have been proposed for the response to biologic treatment to evaluate the efficacy of treatment among patients with chronic rhinosinusitis with nasal polyps (CRSwNP). This review aimed to summarize current response criteria and evaluate response rates of patients with CRSwNP after biologic therapies.

Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from the inception to July 2024 to identify clinical studies exploring the response to biologic treatment in patients with CRSwNP.

Results: Twenty-nine studies were included, comprising 3735 patients in 25 studies suitable for meta-analysis. These were various comprehensive and single criteria for response to biologic therapy in patients with CRSwNP. The comprehensive evaluation measures of patient responsiveness included 5 key outcome measures: nasal polyp size, systemic corticosteroid need, disease-specific quality of life, sense of smell, and impact of comorbidities. The single evaluation measure of treatment response included nasal polyp size, disease-specific quality of life, and sense of smell. The minimum clinically important difference and the thresholds of these parameters are used to determine the clinical improvement or the severity of the disease after treatment. These existing treatment response instruments categorized patients as follows: 4 (excellent, moderate, poor, and no response), 3 (good-to-excellent, moderate-poor, and no response), and 2 (response and no response). The pooled moderate-to-excellent response rate after biologic therapy assessed by comprehensive criteria was from 39.3% (95% confidence interval [CI], 0.231-0.670) to 87.7% (95% CI, 0.774-0.994). The pooled response rates evaluated by the single measures ranged from 62.9% (95% CI, 0.518-0.746) to 82.8% (95% CI, 0.801-0.857).

Conclusion: The critical components and parameters of the response criteria for CRSwNP patients receiving biologic treatment have yet to be reached, leading to significantly heterogeneous response rates to biologics. The development of consistent criteria for the response to biologic treatment is critical to help define treatment efficacy.