New advances in the treatment of chronic rhinosinusitis with nasal polyps from pathophysiology to biologic targeted therapy.

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic airway disease characterized mainly by type 2 inflammation, which seriously impairs patients' quality of life and imposes a huge economic burden. Traditional treatments cannot eradicate underlying immune disorders, leading to high postoperative recurrence. This review aims to summarize the pathophysiological basis of CRSwNP and the clinical application advances of biologics in its precision treatment. METHODS: A narrative review was performed to synthesize key literature on the pathophysiology of CRSwNP, focusing on the core role of type 2 inflammatory molecules (IL-4, IL-13, IL-5, IgE, TSLP) and the clinical evidence of targeted biologics for refractory CRSwNP. RESULTS: In-depth understanding of CRSwNP pathophysiology has promoted the shift to precision medicine. Biologics including dupilumab (anti-IL-4Rα), mepolizumab (anti-IL-5), omalizumab (anti-IgE) and tezepelumab (anti-TSLP) can precisely target key molecules in type 2 inflammatory pathways, achieving effective and long-lasting disease control, reducing polyp volume, improving nasal symptoms and olfactory function, decreasing reliance on oral corticosteroids and the need for reoperation, and exerting synergistic effects on comorbid asthma. CONCLUSIONS: Biologics mark a milestone in CRSwNP treatment, shifting clinical management from symptomatic treatment to individualized decision-making based on patient endotypes, comorbidities and treatment goals such as disease remission. Future research will focus on predictive biomarkers, head-to-head comparative studies and new targets for non-type 2 inflammation to optimize long-term management. By integrating recent biologic evidence with endotype-based recurrence mechanisms, this review provides a practical framework for biologic stewardship and remission-oriented management in CRSwNP.