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Scientific Oral Presentation

Rhinology/Allergy

Comparative Efficacy of Biologics in Reducing Revision Surgery for Chronic Rhinosinusitis with Nasal Polyps Patients

Tuesday, October 20, 2026

7:48 AM - 7:54 AM PT

Location: Theatre

Co-Author(s)

VK

Veenadhari Kollipara, n/a

Medical Student
Penn State College of Medicine
Hershey, Pennsylvania, United States
FL

F. Jeffrey F. Lorenz, MD

Resident Physician, Otolaryngology–Head and Neck Surgery
Penn State University
Hershey, PA, United States

Senior Author(s)

Johnathan D. McGinn, MD FACS

Professor and Vice Chair, Department of Otolaryngology – Head and Neck Surgery
Milton S. Hershey Medical Center / Penn State College of Medicine
Hershey, PA, United States

Presenting Author(s)

Kunal A. Koka, BS

Medical Student
Penn State College of Medicine
Hershey, PA, United States

Disclosure(s):

Johnathan D. McGinn, MD FACS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Kunal A. Koka, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Monoclonal antibodies (biologics) are an effective treatment modality for patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) that have been shown to improve symptom scores, quality of life, and need for repeat surgery. However, efficacy between available biologics is inconclusive when comparing the need for repeat surgery. The aim of this study is to compare the effectiveness of three common biologics in reducing the need for repeat surgery in CRSwNP patients.

Methods: The TriNetX database was queried for adult patients with CRSwNP who received previous nasal surgery. Three cohorts of patients who subsequently received dupilumab, omalizumab, or mepolizumab were created. Cohorts were propensity score matched for age, sex, and other indications for biologic use (asthma, atopic dermatitis, etc). The primary outcome was the lifetime risk of repeat surgery after initiating the biologic. The secondary outcomes included treatment retention and time to repeat surgery.

Results: We identified 3,912 patients in the dupilumab cohort, 784 in the omalizumab cohort, and 1,129 in the mepolizumab cohort. Dupilumab users showed a significantly reduced risk of requiring repeat nasal surgery compared to omalizumab (risk ratio (RR): 0.51, 95% confidence interval (CI): 0.44-0.6, p < 0.0001) and mepolizumab patients (RR: 0.63, 95% CI: 0.54-0.73, p < 0.0001). When compared to mepolizumab, omalizumab patients were at increased risk of repeat surgery (RR: 1.37, 95% CI: 1.19-1.59, p < 0.0001). Dupilumab also showed the highest treatment retention with 75% of patients continuing therapy without switching compared to 48% for mepolizumab and 39% for omalizumab. Patients who discontinued dupilumab showed the shortest time to repeat surgery at 307 days compared to 536 for mepolizumab and 716 for omalizumab.

Conclusions: Dupilumab is most effective in treatment retention, reducing risk of repeat surgery, and time to repeat surgery among patients who discontinued treatment when compared to omalizumab and mepolizumab. Further studies are needed to elucidate the mechanism between the varying efficacies between biologics.