Limited value of routine chest X-rays before biologic therapy in CRSwNP.

INTRODUCTION: Biologic therapies for chronic rhinosinusitis with nasal polyps (CRSwNP) have been approved in Denmark since 2022. Chest X-ray (CXR) was implemented by the Global Airways Steering Group as pre-treatment screening to identify pulmonary conditions and monitor adverse effects. This study evaluates the utility of routine CXR screening before initiating biological therapy in patients with CRSwNP. METHODS: Baseline data, including chest X-ray, were collected prospectively in the nationwide Global Airways Registry (approved by the Danish Research Ethics Committee R. no.: H-21020685) and analysed in May 2025. RESULTS: A total of 511 patients (335 males, 176 females; mean age 46.5 ± 14.6) years were identified and included in this study; 247 patients were initiated on biologic therapy. In the treatment group, 136 (55%) had normal CXRs, and 12 (5%) had abnormal findings. Among the 264 patients who did not receive biologic treatment, 143 (54%) had normal CXRs and ten (4%) demonstrated abnormal findings. CONCLUSIONS: Routine baseline CXR screening before biologic therapy in patients with CRSwNP identified few abnormal findings. Accordingly, routine CXR is likely to offer limited clinical benefit. FUNDING: The Global Airways database is funded by GlaxoSmithKline, Sanofi and Astra Zeneca. None of the pharmaceutical companies has access to data. TRIAL REGISTRATION: Not relevant.