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With recent regulatory approvals, there has been a surge in real\u2010world studies (RWSs). This systematic review and meta\u2010analysis aimed to summarise the efficacy and safety of these four biologics in real\u2010world settings. Primary outcomes were nasal polyp score and sino\u2010nasal outcome test\u201022 score. Secondary outcomes included smell identification test score, loss of smell score, nasal congestion score, overall nasal symptom score, treatment response, and adverse events (AEs) prompting discontinuation. Efficacy outcomes at 4, 6, 12, and over 12\u2009months were summarised, and meta\u2010analyses of mean changes from baseline were conducted. Sixty\u2010four RWSs involving 3921 patients were included. Significant improvements in clinical outcomes were observed at most follow\u2010up time points, with dupilumab showing particularly notable effects. The efficacy observed in these RWSs was superior to that demonstrated in phase 3 RCTs. All biologics exhibited low discontinuation rates due to AEs. Overall, biologic treatments for CRSwNP in real\u2010world settings demonstrate strong efficacy and good safety. However, the limitations in current RWSs highlight the need for long\u2010term, high\u2010quality multicentre prospective studies and comprehensive healthcare database analyses.<\/jats:p>","DOI":"10.1111\/all.16499","type":"journal-article","created":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T04:50:01Z","timestamp":1740199801000},"page":"1256-1270","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Efficacy and Safety of Biologics for Chronic Rhinosinusitis With Nasal Polyps: A Meta\u2010Analysis of Real\u2010World Evidence"],"prefix":"10.1111","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6149-7636","authenticated-orcid":false,"given":"Shiru","family":"Cai","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital Capital Medical University  Beijing People's Republic of China"},{"name":"Beijing Institute of Otorhinolaryngology Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0607-4524","authenticated-orcid":false,"given":"Shenglong","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital Capital Medical University  Beijing People's Republic of China"},{"name":"Beijing Institute of Otorhinolaryngology Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9137-0247","authenticated-orcid":false,"given":"Yan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital Capital Medical University  Beijing People's Republic of China"},{"name":"Beijing Institute of Otorhinolaryngology Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0910-9884","authenticated-orcid":false,"given":"Luo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital Capital Medical University  Beijing People's Republic of China"},{"name":"Beijing Institute of Otorhinolaryngology Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases  Beijing People's Republic of China"},{"name":"Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases Chinese Academy of Medical Sciences  Beijing People's Republic of China"},{"name":"Department of Allergy, Beijing TongRen Hospital Capital Medical University  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/03007995.2020.1815682"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhin20.600"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31881-1"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.05.032"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(21)00097-7"},{"issue":"5","key":"e_1_2_9_7_1","first-page":"576","article-title":"Mepolizumab in CRSwNP\/ECRS and NP: The Phase III Randomised MERIT Trial in Japan, China, and Russia","volume":"62","author":"Fujieda S.","year":"2024","journal-title":"Rhinology"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2021.08.030"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280216669183"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-135"},{"issue":"6","key":"e_1_2_9_11_1","first-page":"552","article-title":"Multi\u2010Institutional Minimal Clinically Important Difference of the 22\u2010Item Sinonasal Outcome Test in Medically Managed Chronic Rhinosinusitis","volume":"59","author":"Phillips K. 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