{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T23:33:02Z","timestamp":1784763182648,"version":"3.55.0"},"reference-count":62,"publisher":"European Respiratory Society (ERS)","issue":"179","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir Rev"],"accepted":{"date-parts":[[2025,11,17]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multiple biologics targeting type 2 inflammation have been evaluated for the treatment of severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) separately.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the efficacy and safety of biologics in patients with comorbid asthma and CRSwNP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review of randomised controlled trials (RCTs) from Medline, Embase, Web of Science and Scopus (up to 31 October 2025) was conducted. Random-effects meta-analysis assessed efficacy and safety outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>16 studies involving 3598 patients were included in the meta-analysis. Overall, biologics reduced asthma exacerbations by 73% (rate ratio 0.27, 95% CI 0.21\u20130.34), increased forced expiratory volume in 1\u2005s by 0.21 L (95% CI 0.11\u20130.30), improved asthma control questionnaire score by \u22120.70 points (95% CI \u22120.83\u2013\u22120.56) and asthma quality of life questionnaire score by 0.71 points (95% CI 0.49\u20130.93). Regarding sino-nasal outcomes, the sino-nasal outcome test 22 (SNOT-22) score was reduced by 15.15 points (95% CI \u221219.64\u2013\u221210.66), the nasal polyp score by 1.39 points (95% CI \u22121.88\u2013\u22120.89), the Lund\u2013Mackay computed tomography score by 6.64 points (95% CI \u22128.88\u2013\u22124.40) and the nasal congestion\/obstruction score by 0.84 points (95% CI \u22121.13\u2013\u22120.54). Heterogeneity across biologic classes varied by outcome, ranging from low to substantial. Overall, biologics exhibited a favourable safety profile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Biologics significantly reduced asthma exacerbations, improved lung function, asthma control and quality of life, and alleviated sino-nasal outcomes in patients with comorbid asthma and CRSwNP, with an acceptable safety profile.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/16000617.0186-2025","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T09:35:22Z","timestamp":1768383322000},"page":"250186","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Efficacy of biologic agents in patients with comorbid asthma and chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis of randomised controlled trials"],"prefix":"10.1183","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8806-2561","authenticated-orcid":false,"given":"Christos","family":"Kyriakopoulos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Ntritsos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athena","family":"Gogali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Papanikolaou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Angelopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9227-1365","authenticated-orcid":false,"given":"Emmanouil D.","family":"Oikonomou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0774-3942","authenticated-orcid":false,"given":"Konstantinos","family":"Kostikas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"2026033102050760000_35.179.250186.1","unstructured":"Global Initiative for Asthma . 2024 GINA main report . Date last accessed: 26 Jun 2025. Date last updated: 22 May 2025. https:\/\/ginasthma.org\/2024-report\/"},{"key":"2026033102050760000_35.179.250186.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2014.08.042"},{"key":"2026033102050760000_35.179.250186.3","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00202013"},{"key":"2026033102050760000_35.179.250186.4","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2008.106609"},{"key":"2026033102050760000_35.179.250186.5","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1080\/03007995.2018.1505352","article-title":"Systematic literature review of the clinical, humanistic, and economic burden associated with asthma uncontrolled by GINA steps 4 or 5 treatment","volume":"34","author":"Chen","year":"2018","journal-title":"Curr Med Res Opin"},{"key":"2026033102050760000_35.179.250186.6","doi-asserted-by":"publisher","DOI":"10.1111\/resp.12957"},{"key":"2026033102050760000_35.179.250186.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)33311-1"},{"key":"2026033102050760000_35.179.250186.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2020.105919"},{"key":"2026033102050760000_35.179.250186.9","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2019-213223"},{"key":"2026033102050760000_35.179.250186.10","doi-asserted-by":"crossref","first-page":"48","DOI":"10.2500\/aap.2019.40.4182","article-title":"A cross-sectional, population-based survey of US adults with symptoms of chronic rhinosinusitis","volume":"40","author":"Palmer","year":"2019","journal-title":"Allergy Asthma Proc"},{"key":"2026033102050760000_35.179.250186.11","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1080\/03007995.2020.1815682","article-title":"Systematic literature review of the epidemiology and clinical burden of chronic rhinosinusitis with nasal polyposis","volume":"36","author":"Chen","year":"2020","journal-title":"Curr Med Res Opin"},{"key":"2026033102050760000_35.179.250186.12","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1016\/j.jaip.2022.03.002","article-title":"Chronic rhinosinusitis with nasal polyps: quality of life in the biologics era","volume":"10","author":"Mullol","year":"2022","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2026033102050760000_35.179.250186.13","doi-asserted-by":"publisher","DOI":"10.4193\/Rhin20.600"},{"key":"2026033102050760000_35.179.250186.14","doi-asserted-by":"crossref","first-page":"2630","DOI":"10.1016\/j.jaip.2023.05.011","article-title":"The unified airway hypothesis: evidence from specific intervention with anti-IL-5 biologic therapy","volume":"11","author":"Bachert","year":"2023","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2026033102050760000_35.179.250186.15","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1016\/j.jaip.2020.09.063","article-title":"Chronic rhinosinusitis with nasal polyps and asthma","volume":"9","author":"Laidlaw","year":"2021","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2026033102050760000_35.179.250186.16","doi-asserted-by":"crossref","first-page":"100036","DOI":"10.1016\/j.allmed.2025.100036","article-title":"Chronic rhinosinusitis, asthma, and gastroesophageal reflux: epidemiology, pathophysiology, and comorbidity","volume":"3","author":"Sun","year":"2025","journal-title":"Allergy Med"},{"key":"2026033102050760000_35.179.250186.17","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/lio2.358","article-title":"Histopathological characteristics of surgical tissue from primary vs recurrent chronic rhinosinusitis with nasal polyposis patients","volume":"5","author":"Donnell","year":"2020","journal-title":"Laryngoscope Investig Otolaryngol"},{"key":"2026033102050760000_35.179.250186.18","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1007\/s12016-023-08976-y","article-title":"Diverse endotypes of chronic rhinosinusitis and clinical implications","volume":"65","author":"Xie","year":"2023","journal-title":"Clin Rev Allergy Immunol"},{"key":"2026033102050760000_35.179.250186.19","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1016\/j.jaip.2022.01.040","article-title":"Targeting downstream type 2 cytokines or upstream epithelial alarmins for severe asthma","volume":"10","author":"Chan","year":"2022","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2026033102050760000_35.179.250186.20","doi-asserted-by":"crossref","first-page":"4235","DOI":"10.1016\/j.jaip.2021.07.023","article-title":"The choice of biologics in patients with severe chronic rhinosinusitis with nasal polyps","volume":"9","author":"Lipworth","year":"2021","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2026033102050760000_35.179.250186.21","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1056\/NEJMoa2406673","article-title":"Twice-yearly depemokimab in severe asthma with an eosinophilic phenotype","volume":"391","author":"Jackson","year":"2024","journal-title":"N Engl J Med"},{"key":"2026033102050760000_35.179.250186.22","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/S0140-6736(25)00197-7","article-title":"Efficacy and safety of twice per year depemokimab in chronic rhinosinusitis with nasal polyps (ANCHOR-1 and ANCHOR-2): phase 3, randomised, double-blind, parallel trials","volume":"405","author":"Gevaert","year":"2025","journal-title":"Lancet"},{"key":"2026033102050760000_35.179.250186.23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2535"},{"key":"2026033102050760000_35.179.250186.24","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"2026033102050760000_35.179.250186.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2014.09.005"},{"key":"2026033102050760000_35.179.250186.26","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"2026033102050760000_35.179.250186.27","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32218-4"},{"key":"2026033102050760000_35.179.250186.28","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1016\/j.jaip.2019.03.023","article-title":"Dupilumab improves patient-reported outcomes in patients with chronic rhinosinusitis with nasal polyps and comorbid asthma","volume":"7","author":"Bachert","year":"2019","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2026033102050760000_35.179.250186.29","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/j.jaci.2021.08.030","article-title":"Efficacy and safety of benralizumab in chronic rhinosinusitis with nasal polyps: a randomized, placebo-controlled trial","volume":"149","author":"Bachert","year":"2022","journal-title":"J Allergy Clin Immunol"},{"key":"2026033102050760000_35.179.250186.30","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1016\/j.jaci.2021.10.040","article-title":"Mepolizumab for chronic rhinosinusitis with nasal polyps: treatment efficacy by comorbidity and blood eosinophil count","volume":"149","author":"Bachert","year":"2022","journal-title":"J Allergy Clin Immunol"},{"key":"2026033102050760000_35.179.250186.31","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/all.14902","article-title":"Benralizumab improves symptoms of patients with severe, eosinophilic asthma with a diagnosis of nasal polyposis","volume":"77","author":"Canonica","year":"2022","journal-title":"Allergy"},{"key":"2026033102050760000_35.179.250186.32","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201103-0396OC"},{"key":"2026033102050760000_35.179.250186.33","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1177\/19458924211030486","article-title":"Defining the efficacy of omalizumab in nasal polyposis: a POLYP 1 and POLYP 2 subgroup analysis","volume":"36","author":"Damask","year":"2022","journal-title":"Am J Rhinol Allergy"},{"key":"2026033102050760000_35.179.250186.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2012.07.047"},{"key":"2026033102050760000_35.179.250186.35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/JAA.S420140","article-title":"Dupilumab reduces asthma disease burden and recurrent SCS use in patients with CRSwNP and coexisting asthma","volume":"17","author":"Gurnell","year":"2024","journal-title":"J Asthma Allergy"},{"key":"2026033102050760000_35.179.250186.36","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1016\/S2213-2600(21)00097-7","article-title":"Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): a randomised, double-blind, placebo-controlled, phase 3 trial","volume":"9","author":"Han","year":"2021","journal-title":"Lancet Respir Med"},{"key":"2026033102050760000_35.179.250186.37","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1016\/j.jaci.2020.02.002","article-title":"Severe eosinophilic asthma with nasal polyposis: a phenotype for improved sinonasal and asthma outcomes with mepolizumab therapy","volume":"145","author":"Howarth","year":"2020","journal-title":"J Allergy Clin Immunol"},{"key":"2026033102050760000_35.179.250186.38","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1007\/s12325-024-03006-5","article-title":"Effect of tezepelumab on sino-nasal outcome test (SNOT)-22 domain and symptom-specific scores in patients with severe, uncontrolled asthma and a history of chronic rhinosinusitis with nasal polyps","volume":"42","author":"Jacobs","year":"2025","journal-title":"Adv Ther"},{"key":"2026033102050760000_35.179.250186.39","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.anai.2021.01.012","article-title":"Dupilumab improves upper and lower airway disease control in chronic rhinosinusitis with nasal polyps and asthma","volume":"126","author":"Laidlaw","year":"2021","journal-title":"Ann Allergy Asthma Immunol"},{"key":"2026033102050760000_35.179.250186.40","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1056\/NEJMoa2414482","article-title":"Tezepelumab in adults with severe chronic rhinosinusitis with nasal polyps","volume":"392","author":"Lipworth","year":"2025","journal-title":"N Engl J Med"},{"key":"2026033102050760000_35.179.250186.41","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.jaip.2018.08.021","article-title":"Effects of reslizumab on asthma outcomes in a subgroup of eosinophilic asthma patients with self-reported chronic rhinosinusitis with nasal polyps","volume":"7","author":"Weinstein","year":"2019","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2026033102050760000_35.179.250186.42","unstructured":"American Thoracic Society . Asthma Control Questionnaire (ACQ). Date last accessed: 26 Jun 2025. Date last updated: 2025. www.thoracic.org\/members\/assemblies\/assemblies\/srn\/questionaires\/acq.php"},{"key":"2026033102050760000_35.179.250186.43","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(94)90036-1"},{"key":"2026033102050760000_35.179.250186.44","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1002\/alr.22028","article-title":"Investigating the minimal clinically important difference for SNOT-22 symptom domains in surgically managed chronic rhinosinusitis","volume":"7","author":"Chowdhury","year":"2017","journal-title":"Int Forum Allergy Rhinol"},{"key":"2026033102050760000_35.179.250186.45","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1002\/lary.29888","article-title":"Estimating clinically meaningful change of efficacy outcomes in inadequately controlled chronic rhinosinusitis with nasal polyposis","volume":"132","author":"Han","year":"2022","journal-title":"Laryngoscope"},{"key":"2026033102050760000_35.179.250186.46","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"2026033102050760000_35.179.250186.47","unstructured":"Higgins JPT , Thomas J , Chandler J , et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.5. Date last accessed: 27 July 2025. Date last updated: August 2024. www.cochrane.org\/authors\/handbooks-and-manuals\/handbook"},{"key":"2026033102050760000_35.179.250186.48","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.molmed.2022.09.001","article-title":"Asthma exacerbations: the Achilles heel of asthma care","volume":"28","author":"McIntyre","year":"2022","journal-title":"Trends Mol Med"},{"key":"2026033102050760000_35.179.250186.49","doi-asserted-by":"publisher","DOI":"10.2147\/JAA.S176026"},{"key":"2026033102050760000_35.179.250186.50","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0238-2023"},{"key":"2026033102050760000_35.179.250186.51","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1704064"},{"key":"2026033102050760000_35.179.250186.52","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1703501"},{"key":"2026033102050760000_35.179.250186.53","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30307-5"},{"key":"2026033102050760000_35.179.250186.54","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.otc.2022.09.001","article-title":"Unified airway disease: a contemporary review and introduction","volume":"56","author":"Fokkens","year":"2023","journal-title":"Otolaryngol Clin North Am"},{"key":"2026033102050760000_35.179.250186.55","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0181-2024"},{"key":"2026033102050760000_35.179.250186.56","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2108009"},{"key":"2026033102050760000_35.179.250186.57","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1111\/all.12789","article-title":"Prevalence and reversibility of lung hyperinflation in adult asthmatics with poorly controlled disease or significant dyspnea","volume":"71","author":"Perez","year":"2016","journal-title":"Allergy"},{"key":"2026033102050760000_35.179.250186.58","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0137-2019"},{"key":"2026033102050760000_35.179.250186.59","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31324-1"},{"key":"2026033102050760000_35.179.250186.60","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1304048"},{"key":"2026033102050760000_35.179.250186.61","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199912233412603"},{"key":"2026033102050760000_35.179.250186.62","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/S2213-2600(25)00287-5","article-title":"Dupilumab versus omalizumab in patients with chronic rhinosinusitis with nasal polyps and coexisting asthma (EVEREST): a multicentre, randomised, double-blind, head-to-head phase 4 trial","volume":"13","author":"De Corso","year":"2025","journal-title":"Lancet Respir Med"}],"container-title":["European Respiratory Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/16000617.0186-2025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T09:05:19Z","timestamp":1774947919000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/16000617.0186-2025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":62,"journal-issue":{"issue":"179","published-online":{"date-parts":[[2026,1,14]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1183\/16000617.0186-2025"],"URL":"https:\/\/doi.org\/10.1183\/16000617.0186-2025","relation":{},"ISSN":["0905-9180","1600-0617"],"issn-type":[{"value":"0905-9180","type":"print"},{"value":"1600-0617","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}