Update on the Nasal Polyp Score

Most patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have type 2 inflammation, as do patients with eosinophilic asthma [1-3]. Asthma often accompanies CRSwNP [4, 5], and CRSwNP with comorbid asthma is associated with more severe sinonasal disease [5-7]. Furthermore, asthma is more prone to exacerbations when comorbid CRSwNP is present [5, 8]. The aim of this study was to describe the prevalence of asthma and evaluate asthma control in patients with uncontrolled CRSwNP undergoing endoscopic sinus surgery (ESS) at a tertiary centre. We also aimed to identify factors associated with asthma in this population. This cross-sectional study was conducted as part of a prospective controlled multicentre trial (AirGOs Operative) investigating the benefits of complete and limited ESS in patients with uncontrolled CRSwNP. Patients suffering from uncontrolled CRSwNP, a Sinonasal Outcome Test-22 (SNOT-22) score ≥30, a nasal polyp (NP) score ≥4, a Lund–Mackay (LM) score ≥14 and at least one of the following: ≥1 previous surgery for CRSwNP, ≥1 oral corticosteroid course or ≥3 antibiotic courses during the past 2 years were included in this study. In addition to basic characteristics and comorbidities, the data in this study comprised preoperative nasoendoscopy, NP and LM scores, exhaled nitric oxide (eNO), blood eosinophil count (B-eos), serum immunoglobulin E concentration (S-IgE), serum allergen-specific IgE measurements, Sniffin' Sticks Screening 12 Test (SST-12) and Health-Related Quality of Life (HRQoL) of the upper and lower airways (SNOT-22, Asthma Control Test [ACT] and 15D). Asthma was assessed and diagnosed systematically. Previous asthma diagnosis was based on medical record information for physician-diagnosed asthma. The prevalence of previous physician-diagnosed asthma (AB), asthma diagnosed in the preoperative tests (preAB), and no asthma were calculated. All the patients underwent spirometry and a bronchodilator test and peak expiratory flow (PEF) recording preoperatively [9]. Methacholine challenge test was performed for patients with asthma symptoms (prolonged or night-time cough, wheezing or shortness of breath with or without auscultatory wheezing) but without AB and with undiagnostic results in spirometry and PEF recording. In spirometry, improvement with a bronchodilator in forced expiratory volume in the first second (FEV1) or forced vital capacity of at least 12% and 200 mL was considered diagnostic for asthma [9]. In PEF recording, diurnal variability (≥20% and 60 L/min at least three times) or bronchodilator responsiveness (≥15% and 60 L/min at least three times) was considered diagnostic for asthma. In the methacholine challenge test, moderate or severe hyperreactivity (a cumulative dose of ≤600 μg inhaled methacholine causes a 20% reduction in FEV1) was considered diagnostic for asthma. Uncontrolled asthma in AB and preAB patients was defined as one or more of the following: ACT score <20 [9] or significant reversible airflow obstruction in PEF recording or spirometry. Statistical analyses were performed with the chi-squared test, permutation test, Kruskall–Wallis test, analysis of variance, t-test, Mann–Whitney U-test and logistic regression analysis for odds ratio. Of the 87 patients with uncontrolled CRSwNP, 69 (79%) suffered from asthma preoperatively. Fifteen patients (17%) had previously undiagnosed asthma (preAB). Eighty per cent of the patients had severely decreased HRQoL, with SNOT-22 ≥ 40. There were no differences between the AB, preAB and no-asthma groups in sex, body mass index (BMI), mean age, prevalence of high scores in questions 6 and 14 evaluating cough and night awakening in SNOT-22, ASA intolerance or NP, LM or SST-12 scores. The prevalence of allergic rhinitis was more common in the AB and preAB groups (n = 28, 52%, and n = 9, 60%, respectively) than in the no-asthma group (n = 3, 17%) (p = 0.017). B-eos was elevated in all the groups (mean 0.54 E9/L, SD 0.41, range 0–2.84 in the whole study population) but did not differ between the groups (Table 1). In patients with AB, eNO was higher than in those with no asthma (p = 0.041), but the relationship between asthma (preAB or AB) and eNO was not significant after adjusting for smoking and allergic rhinitis (p = 0.11). Allergic rhinitis had a relationship with asthma (AB or preAB) in multivariate analysis (odds ratio 5.41, 95% CI 1.24–23.61) when sex, age, BMI, smoking status and ASA intolerance were included. There was a weak correlation between the SNOT-22 and ACT scores (−0.23 [95% CI −0.42 to −0.01]). ACT total score < 20, n (%) Asthma was uncontrolled preoperatively in 40 (58%) patients suffering from asthma. Sex, age, BMI, smoking status, ASA intolerance, allergic rhinitis, B-eos, NP score, LM score, anosmia and eNO did not differ between the controlled and uncontrolled asthma groups. The small sample size was a limitation of this study, and the results should be verified with studies in other populations and with larger sample sizes. These results are likely to be applicable to patients with the clinical assessment criteria used and an indication for surgery. Most patients in this study had severely decreased HRQoL, with a SNOT-22 score of at least 40. The strengths of this study were its systematic evaluation of HRQoL with the SNOT-22, ACT and 15D questionnaires and its concurrent examination of the upper airway (LM and NP scores, SST-12) and lower airway (spirometry, PEF recording and eNO). Asthma is known to exacerbate the symptoms of CRSwNP. These results show that asthma and uncontrolled asthma are commonly found in patients with uncontrolled CRSwNP undergoing sinus surgery. These patients benefit from a comprehensive evaluation of both upper and lower airway diseases preoperatively. Data collection was performed by E.G., J.S., A.L.-H., M.L., S.H.-M., L.H., A.M., S.V., S.T.-S., and P.V. The planning of the study, data analyses, and interpretation were performed by E.G., P.K., S.T.-S., and P.V. The manuscript was written by E.G., P.K., J.S., A.L.-H., M.L., S.H.-M., L.H., A.M., S.V., S.T.-S., and P.V. This work was funded by Helsinki University Hospital research funds, The Paulo Foundation, The Foundation in Memory of Dorothea Olivia, Karl Walter and Jarl Walter Perklén, Tampere Tuberculosis Foundation, Jalmari and Rauha Ahokas Foundation, Mjölbolsta Foundation of Medical Research, Allergy Research Foundation, Foundation of the Finnish Anti-Tuberculosis Association, state funding for university-level health research, and a Helsinki ENT Hospital grant from Finnish ORL-HNS Foundation. The funders were not involved in the study design, data collection, analysis and interpretation, manuscript writing, or decision-making regarding the submission of the work. We want to thank study nurses Elisa Piccinini, Deniza Salihi, and Catharina Pomoell for their contributions and assistance in the data collection. The study nurses were funded by a Helsinki ENT Hospital grant from Finnish ORL-HNS Foundation and Tampere Tuberculosis Foundation. We also want to thank Hannu Kautiainen, PhD, for providing us with a statistical consultancy. Research permission (HUS/66/2018) was granted on June 21, 2018, by the Institutional Review Board of Helsinki University Hospital and ENT Hospital and was extended on February 22, 2023 (HUS/53/2023). The Research Ethical Board of the Helsinki and Uusimaa Hospital District approved the study design (HUS/1801/2017) on September 14, 2017. Informed consent was obtained from the study participants. The study was registered in ClinicalTrials.gov, NCT03704415. E.G. reports a lecture fee from GlaxoSmithKline, a manuscript fee from the Finnish doctors' society Duodecim, and an abroad congress fee from Orion. P.K. reports lecturing fees from GlaxoSmithKline, consultancies for Swedish Orphan Biovitrum and the Finnish Patient Insurance Center, grants from Allergy Research Foundation, positions as Principal Investigator for Theravance Pan Janus kinase inhibitor TD-0903 and president of the Finnish Respiratory Society. J.S. reports a congress fee from Sanofi and consultancy for GlaxoSmithKline. A.L.-H. reports consultancies for GlaxoSmithKline, Sanofi and Galenus Health, congress fees from Karl Storz, a confidential post at European Rhinologic Society delegate and a grant from Sanofi. S.T.S. reports consultancies for ALK-Abelló, AstraZeneca, Clario, GlaxoSmithKline, Novartis, Sanofi, Orion, Roche Products and grants from GlaxoSmithKline and Sanofi. P.V. reports lecturing fees from Sanofi and GlaxoSmithKline. M.L., S.H.-M., L.H., A.M. and S.V. report no conflicts of interest. The data are available from the corresponding author upon reasonable request. They are stored in a controlled access data storage at Helsinki University Hospital.

Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) is a refractory subtype of chronic rhinosinusitis with nasal polyps (CRSwNP), with clinical characteristics differing from those of non-ECRSwNP. We aimed to explore the predictive value of clinical characteristics, including medical history, symptoms, and signs, prior to ECRSwNP diagnosis, and to develop a nomogram for use in clinical practice. A total of 502 patients with CRSwNP were enrolled. Based on the degree of eosinophilic infiltration in nasal polyps (NPs), patients were classified as ECRSwNP or non-ECRSwNP group. Participants' demographic characteristics, asthma history, severity of nasal symptoms (nasal obstruction, rhinorrhea, hyposmia, and facial pain/headache) according to the visual analog scale, and nasal polyp scores based on polyp scoring system were recorded. Logistic regression analysis was performed to screen for independent risk factors, and a model nomogram was constructed. The percentage of asthmatic patients and the hyposmia, rhinorrhea, and total nasal symptom scores were significantly higher in ECRSwNP patients than that in non-ECRSwNP patients. The nasal polyp score was lower in the eosinophilic group than that in the non-eosinophilic group. Logistic regression analysis revealed that asthma history and hyposmia, rhinorrhea and nasal polyp scores were independent predictors of ECRSwNP. A nomogram consisting of these four independent risk factors was constructed, and its C-index was 0.808 (95% CI, 0.771 to 0.846). The nomogram based on asthma history and olfactory, rhinorrhea, and nasal polyp scores could help predict ECRSwNP, providing a simple, fast, and practical way to distinguish ECRSwNP from non-ECRSwNP cases in clinical practice.

Heterogeneous inflammatory patterns in chronic rhinosinusitis without nasal polyps in Chicago, Illinois

Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a chronic inflammatory condition of the nasal and paranasal sinus mucosa with nasal polyp formation. This systematic review evaluated the efficacy and safety of biological therapies, including omalizumab, mepolizumab, and benralizumab, compared with endoscopic sinus surgery (ESS) in CRSwNP management. A literature search using the PubMed, Scopus, and Web of Science databases identified five studies that met the inclusion criteria. The studies included randomized controlled trials and observational studies assessing biological therapies or ESS in adults with CRSwNP. The primary outcomes were nasal polyp score (NPS), nasal congestion score, Sinonasal Outcome Test (SNOT-22), and adverse events. Omalizumab showed significant improvements in NPS, nasal congestion score, and SNOT-22 scores compared to placebo, with sustained effects in an open-label extension study. Mepolizumab significantly reduced SNOT-22 scores, improved lung function, and decreased blood eosinophil counts and systemic corticosteroid use in patients with severe eosinophilic asthma and CRSwNP. Benralizumab improved NPS and nasal blockage scores compared to placebo, with effects varying by comorbidities and baseline characteristics. ESS with medical therapy showed better SNOT-22 scores than medical therapy alone, though not reaching the minimal clinically important difference. Biological therapies and ESS were well tolerated, with adverse events comparable to those of the placebo. This review demonstrates the effectiveness of biological therapies and ESS in managing CRSwNP, particularly in severe cases of the disease. Further research is needed to evaluate the long-term efficacy, safety, and cost-effectiveness of these interventions in CRSwNP management.

Suppressor of cytokine signaling 3 expression is diminished in sinonasal tissues from patients with chronic rhinosinusitis with nasal polyps

Efficacy and safety of benralizumab in chronic rhinosinusitis with nasal polyps: A randomized, placebo-controlled trial

There is an emerging body of research on targeted biologic therapies for the treatment of severe inflammatory nasal disorders, especially chronic rhinosinusitis with nasal polyposis (CRSwNP). This paper will evaluate the efficacy of biologic therapies for severe nasal inflammation by summarizing key preclinical trials of biologics for animal models of allergic rhinitis and the recent phase 2 and 3 clinical trials of biologic therapies for CRSwNP. Biologics that target the IL-4 receptor (dupilumab), IgE (omalizumab), and IL-5 (mepolizumab, reslizumab, and benralizumab) in patients with CRSwNP have shown improvement of various metrics including Sino-Nasal Outcome Test (SNOT-22) scores, Nasal Polyp Scores (NPS), Nasal Congestion Scores (NCS), and Lund-Mackay sinus opacification scores. The efficacy demonstrated through the dupilumab phase 3 trials (LIBERTY NP SINUS-24 and SINUS-52) led to approval of the first biologic for the treatment of CRSwNP. Phase 3 trials for omalizumab (POLYP 1 and 2) and mepolizumab (SYNAPSE study) and post hoc analyses of phase 3 asthma studies for reslizumab and benralizumab have also demonstrated positive results for the use of biologics for patients with CRSwNP. Future efficacy studies and risk/benefit and cost analyses of these biologics and other cytokine targets for allergic rhinitis with and without nasal polyposis need to be performed.

Efficacy and safety of omalizumab in nasal polyposis: 2 randomized phase 3 trials

BackgroundSubjective and objective evaluations of chronic rhinosinusitis with nasal polyps (CRSwNP) are often discordant.ObjectiveThis study aimed to investigate the feasibility of using a newly developed five-item Sino-Nasal Outcome Test (SNOT-5) to evaluate disease severity and to compare its results with objective assessments in patients with CRSwNP.MethodsAdult patients with bilateral CRSwNP planning to undergo sinus surgery were prospectively enrolled. The nasal polyp score (NPS), Lund-Mackay (L-M) score, olfactory cleft opacification (OC) score, and the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire were assessed. The SNOT-5 scores were retrospectively extracted from the SNOT-22 results. Three-month postoperative endoscopic modified Lund-Kennedy (MLK) scores and SNOT-22 data were collected when available.ResultsA total of 169 participants were enrolled. The SNOT-5 score rather than the SNOT-22 score, was significantly correlated with objective measurements of disease burden, including NPS, L-M, and OC scores. SNOT-5 score was significantly associated with younger age, comorbid asthma, NPS, L-M, and OC scores in the univariate regression analysis, and with age, L-M, and OC scores in the multivariate analysis. Additionally, the SNOT-5 score also significantly correlated with the MLK score at 3 months after surgery.ConclusionThe SNOT-5, rather than the SNOT-22, correlated more closely with objective measures of disease burden, including the NPS and L-M scores, and postoperative MLK score in patients with CRSwNP. Utilizing the SNOT-5 in clinical practice may help clinicians more accurately assess disease severity and treatment response in patients with CRSwNP.

Objectives. Chronic rhinosinusitis with nasal polyps (CRSwNP) demonstrates a high recurrence rate following endoscopic sinus surgery (ESS). The role of adjunctive biologic therapy remains incompletely understood. This study aims to assess the efficacy of dupilumab when used in conjunction with ESS for patients with CRSwNP.Methods. We conducted a retrospective cohort study of type 2 CRSwNP patients who underwent ESS. The study compared patients receiving postoperative dupilumab with those receiving standard care. Changes in the Lund-Kennedy endoscopic score (LKES) and nasal polyp score (NPS) were recorded, and linear mixed models (LMMs) were employed for the primary outcome analysis.Results. The study enrolled 49 CRSwNP patients, with 22 patients in the dupilumab group. Postoperative LKES and NPS decreased in both groups. LMM analysis revealed a significant improvement in LKES (B=–0.61; 95% CI, –0.90 to –0.31; P<0.001) and a more pronounced improvement in NPS (B=–0.14; 95% CI, –0.25 to –0.02; P=0.025) in the dupilumab group compared to controls from preoperative to postoperative measurements.Conclusion. Compared to ESS alone, the adjunctive use of dupilumab in the postoperative period was associated with greater reductions in both NPS and endoscopic scores.

BackgroundThe human monoclonal antibody dupilumab blocks interleukin (IL)‐4 andIL‐13, key and central drivers of type 2 inflammation. Dupilumab, on background mometasone furoate nasal spray (MFNS), improved outcomes in the phase III SINUS‐52 study (NCT02898454) in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP). This posthoc analysis of SINUS‐52 examined whether eosinophilic status of CRSwNP was a predictor of dupilumab efficacy.MethodsPatients were randomized 1:1:1 to dupilumab 300 mg every 2 weeks (q2w) until week 52; dupilumab 300 mg q2w until Week 24, then 300 mg every 4 weeks until week 52; or placebo (MFNS) until week 52. Coprimary endpoints were change from baseline in nasal polyps score (NPS), nasal congestion (NC), and Lund‐Mackay score assessed by CT (LMK‐CT) at week 24. Patients (n = 438) were stratified by eosinophilic chronic rhinosinusitis (ECRS) status according to the Japanese Epidemiological Survey of Refractory Eosinophilic Rhinosinusitis algorithm.ResultsDupilumab significantly improved NPS, NC, and LMK‐CT scores versus placebo at week 24 in all ECRS subgroups (p < 0.001), with improvements maintained or increased at week 52 (p < 0.001). There was no significant interaction between ECRS subgroup (non‐/mild or moderate/severe) and dupilumab treatment effect for all endpoints at weeks 24 and 52 (p > 0.05), except LMK‐CT at week 24 (p = 0.0275). Similar results were seen for the secondary endpoints. Dupilumab was well tolerated across all ECRS subgroups.ConclusionDupilumab produced consistent improvement in symptoms of severe CRSwNP irrespective of ECRS status. Therefore, blood eosinophil level may not be a suitable biomarker for dupilumab efficacy in CRSwNP.

Recent evidence recommends the use of biologics in patients with severe uncontrolled type 2 chronic rhinosinusitis with nasal polyp (CRSwNP) owing to its propensity for recurrence after functional endoscopic sinus surgery (FESS). Among the type 2 biologics used for the treatment of nasal polyps, dupilumab (Dupi, anti-IL-4) exhibited superior efficacy and safety in indirect comparison studies. This study aimed to evaluate the objective and subjective outcomes of patients with CRSwNP treated with and without adjuvant Dupi therapy after FESS. Adult patients with type 2 CRSwNP who underwent FESS with adjuvant Dupi after surgery were enrolled. A matched control group without adjuvant Dupi therapy were recruited during the same period. All patients underwent nasal endoscopy and completed the sinonasal outcome test-22 questionnaire evaluations at baseline and 3 months after surgery. A total of 10 patients who received postoperative adjuvant therapy with Dupi and 20 patients who underwent surgery only were included. Patients with add-on Dupi therapy had significantly higher eosinophil cationic protein levels in the serum, eosinophil counts in peripheral blood, prevalence of asthma, and nasal polyp score at baseline. Both treatments were effective in reducing the patient's symptoms by SNOT-22 at 3 months postoperatively. However, patients with adjuvant Dupi therapy exhibited significantly better endoscopic scores than those with surgery only (p = .022). Surgery plays an important role in treating patients with CRSwNP, and adjuvant Dupi use may facilitate objective mucosal recovery postoperatively. 4.

Eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) and non-eosinophilic chronic rhinosinusitis with nasal polyps (neCRSwNP) are two distinct endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP). The aim of the study was to find the prevalence of eCRSwNP and neCRSwNP, their clinical comparison and to establish predictive values for clinical and diagnostic factors to differentiate between eCRSwNP and neCRSwNP in Indian population with CRSwNP. This study was a prospective cohort, multi- institutional study. A total of 162 patients who were diagnosed with nasal polyps at different military hospitals in India during the period from 2011 to 2020 were selected for study. They were diagnosed in accordance with EPOS guidelines. They were randomly divided into two groups as eCRSwNP and neCRSwNP based on the response to oral corticosteroids for 2weeks duration and the prevalence of eCRSwNP was established. Blood samples were collected and endoscopic sinus surgery was performed in all patients after atleast 2months of last steroid dose. Preop CT scan scores, preop nasal endoscopy scores, preop blood eosinophil counts, preop tissue eosinophil counts were compared between the groups. Postop followup was done at 6months by comparing CT scan scores and nasal endoscopy scores. Predictive values for clinical and diagnostic factors were established to diagnose eCRSwNP in Indian population. Out of a total 162 patients, 121 (74.6%) patients were classified into eCRSwNP and 41 (23.6%) into neCRSwNP out of a total of 162 patients with CRSwNP. CRSwNP was seen in the 4th decade. eCRSwNP was seen in the later part and neCRSwNP was seen in the early part. eCRSwNP was more common in males and neCRSwNP was more common in females. Smoking, asthma and aspirin intolerance were more commonly seen in eCRSwNP than neCRSwNP, p < 0.001, p = 0.020 respectively. Preop total CT scan score, preop bood absolute eosinophil count,preop blood eosinophil percentage, tissue eosinophil percentage, postop nasal endoscopy score, postop CT scan score were stastically significant in eCRSwNP, p < 0.001 except preop total nasal endoscopic score. Tissue absolute eosinophil count had best predictive accuracy plotted with receiver operating characteristic (ROC) curve analysis, area under curve (AUC) 0.923(95% CI, 0.876-0.970). The cutoff points determined to diagnose eCRSwNP were ≥ 15 for preop total CT scan score, ≥ 378 × 106/L for preop absolute blood eosinophil count, ≥ 6.5% for preop blood eosinophil percentage, ≥ 14% for tissue eosinophil percentage, ≥ 16 for absolute tissue eosinophil count, ≥ 1 for 6months postop total nasal endoscopy score, ≥ 2 for 6months postop total CT scan score. eCRSwNP and neCRSwNP are two distinct endotypes of nasal polyps present in Indian population with CRSwNP. Two thirds of the patients with nasal polyps were eCRSwNP and the prevalence in Indian population is more than the East Asian population but less than the Western population. There is a high chance of recurrence and treatment failures for eCRSwNP than neCRSwNP. The cutoff points for various non invasive diagnostic predictors are useful to diagnose the patients with eCRSwNP during the outpatient visits and hence plan for better treatment strategies.

Type 2 inflammatory diseases (T2D), notably severe eosinophilic asthma (SEA) and chronic rhinosinusitis with nasal polyps (CRSwNP), represent a significant global health burden due to their high morbidity, frequent exacerbations and reliance on systemic glucocorticoids (SGCs). Targeting Interleukin-5 (IL-5), a key driver of eosinophil production and survival, has emerged as a validated therapeutic strategy. Depemokimab is a novel, first-in-class anti-IL-5 monoclonal antibody (mAb) engineered with an extended half-life via the YTE amino acid modification of its Fc region, enabling an unprecedented twice-yearly dosing interval. This review synthesizes clinical data from the Phase III SWIFT (SEA) and ANCHOR (CRSwNP) programs, demonstrating depemokimab’s sustained eosinophil depletion and significant reduction in asthma exacerbation rates (annualized asthma exacerbation rate reduction of approximately 54% versus placebo). While efficacy on secondary endpoints such as lung function (FEV1) and quality of life (QoL) was mixed, the efficacy in reducing nasal polyp size (Nasal Polyp Score and Nasal Congestion) in CRSwNP was clear. The core value proposition of depemokimab is the combination of established IL-5 inhibition efficacy with patient convenience due to its dosing. We discuss its pharmacodynamic profile, safety and pivotal role in shifting the treatment paradigm towards simplified chronic disease management, positioning depemokimab as a novel, patient-centric option in the competitive landscape of T2 biologic therapies.

&lt;b&gt;Introduction:&lt;/b&gt; Primary chronic rhinosinusitis with nasal polyps (CRSwNP) is a severe, often uncontrolled disease whose pathomechanism involves type 2 inflammation (T2). Biologic drugs targeting interleukin 4 and 13 (dupilumab) receptors and blocking interleukin 5 (mepolizumab) have been approved for the treatment of the T2 endotype.&lt;b&gt;Aim:&lt;/b&gt; Presentation of the authors' suggestions that guided the choice of an appropriate biologic agent when initiating qualification for the treatment of patients with CRSwNP, based on the authors' experience and data from the literature related to biologic therapy.&lt;b&gt;Materials and methods:&lt;/b&gt; Patients with CRSwNP were qualified for biological treatment in accordance with the EPOS (European Position Paper on Rhinosinusitis) guidelines and the criteria of the B.156 drug program. The choice of an appropriate biologic was based on medical history data, such as the level of asthma control, presence of allergies, and the occurrence of N-ERD (nonsteroidal anti-inflammatory drug-exacerbated respiratory disease), as well as biomarker results: total IgE concentration and absolute blood eosinophil count.&lt;b&gt;Results:&lt;/b&gt; The study included 43 patients (23 treated with mepolizumab, 20 treated with dupilumab). Groups of patients were comparable in terms of age, sex, number of sinonasal surgeries, prevalence of asthma, NSAIDs (non-steroidal anti-inflammatory drugs) sensitivity, atopy and initial SNOT-22 (Sinonasal Outcome Test-22), VAS (Visual Analog Scale), NPS (Nasal Polyp Score), and L-K score (Lund-Kennedy score). Eosinophilia total range was 250-1000 cells/microL. Baseline peripheral blood eosinophil count was significantly higher in the mepolizumab-treated group. In the dupilumab-treated group, increases in eosinophil counts up to 3500 cells/μl were observed during therapy; however, no patient developed clinical features of hypereosinophilic syndrome.&lt;b&gt;Conclusions:&lt;/b&gt; When selecting a biologic drug for the treatment of CRSwNP, it is recommended to consider not only the values of available biomarkers, but also the degree of asthma control, the cumulative dose of oral corticosteroids (OCSs), the patient's age, and treatment convenience for the patient.