Biologic treatment for nasal polyps
Targeted antibody injections that shrink nasal polyps, improve smell and reduce the need for repeated steroids or surgery when standard treatment has not been enough.
Biologics are monoclonal antibodies that block specific parts of the inflammatory pathway driving nasal polyps. Three are in regular use for chronic rhinosinusitis with nasal polyps (CRSwNP): omalizumab, dupilumab and tezepelumab. Each works on a different part of the same broad pathway, and the right choice depends on your disease pattern, blood tests, and any associated conditions such as asthma. Mr Gane has a clinical and research interest in this area and offers all three.
Why a biologic might be offered
A biologic may be offered when polyps cause significant blockage, loss of smell or poor sleep and have not responded well enough to nasal steroid sprays, rinses, occasional oral steroid courses or surgery. The aims are to shrink the polyps, improve breathing and smell, reduce the need for repeated oral steroid courses, and reduce the need for further surgery. Biologics are not a cure: stopping treatment usually allows the disease to return over months, so they are used as ongoing therapy in suitable patients.
The three biologics
Omalizumab (Xolair)
Omalizumab binds to immunoglobulin E (IgE) and lowers the allergic signal. It is most useful where the disease is driven by allergy and IgE is high. It has long-standing experience in allergic asthma and chronic urticaria, and is licensed for CRSwNP. The dose and frequency (every two to four weeks) depend on body weight and total IgE.
Dupilumab (Dupixent)
Dupilumab blocks the IL-4 and IL-13 pathways, two key drivers of Type 2 inflammation in the nose, sinuses and lungs. It has strong evidence in CRSwNP, with reliable polyp shrinkage and recovery of the sense of smell in many patients. It is given by injection under the skin, usually every two weeks. It also treats severe atopic eczema and Type 2 asthma if those are present.
Tezepelumab (Tezspire)
Tezepelumab acts further upstream, blocking thymic stromal lymphopoietin (TSLP) and so dampening multiple inflammatory pathways at once. It is established in severe asthma, with growing evidence in CRSwNP, and can work where the disease is not strongly eosinophilic or IgE-driven. It is given by injection under the skin every four weeks.
Choosing between them
The choice is based on your specific picture: blood eosinophils, total IgE and allergy status, the presence of asthma or eczema, how often you have needed oral steroids, response to previous surgery, and practical factors such as injection frequency. None of these biologics is right for every patient, and the choice is made together at consultation.
How they are given
All three are given as injections under the skin. After training, many patients self-inject at home. The benefits are gradual and usually take several weeks. Regular follow-up checks the response and any side effects.
Side effects across the class
- Injection-site reactions such as redness, swelling or discomfort
- Eye symptoms (most often with dupilumab), such as conjunctivitis or dry, sore eyes
- A temporary rise in eosinophils on blood tests with some agents
- Occasional headache, sore throat or joint aches
- Rarely, allergic reactions
These biologics are not broadly immunosuppressive and there is no current evidence that they increase cancer risk. Live vaccines should be avoided during treatment; non-live vaccines (including flu, COVID and pneumococcal) are safe and recommended.
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This guide is general information and not a substitute for individual medical advice. Contact the practice if you have questions about your own care.