Seven biologics are now in play for severe chronic rhinosinusitis with nasal polyps (CRSwNP), with no head-to-head trials among them. In JACI, Ouranos and colleagues compared them indirectly in a systematic review and network meta-analysis of 15 randomized trials (n=3,642): dupilumab, omalizumab, mepolizumab, benralizumab, depemokimab, tezepelumab, and stapokibart. The primary outcomes were changes in nasal polyp score and nasal congestion score at 20–24 and 48–56 weeks.
At 20–24 weeks, dupilumab and stapokibart produced greater reductions in polyp and congestion scores than depemokimab, omalizumab, and benralizumab. There was no significant difference between dupilumab and stapokibart on either outcome.
At 48–56 weeks, dupilumab and tezepelumab led, with greater reductions than depemokimab, mepolizumab, or benralizumab — and again, no significant difference between dupilumab and tezepelumab.
Safety was comparable across all seven agents.
The bottom line: dupilumab is the only agent at the top at both time points, and it remains the best-supported choice on indirect evidence. Neither stapokibart early nor tezepelumab late was shown superior to dupilumab — that question can only be settled by direct, head-to-head comparative trials.
References:
Ouranos K, et al. J Allergy Clin Immunol. 2026;158(4):1047-1057.
DOI: 10.1016/j.jaci.2026.06.016