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Baseline blood eosinophil count ≥150 cells/µL identifies CRSwNP patients who achieve greater reductions in nasal polyp size and congestion with biologic therapy.
A new systematic review and meta-analysis highlights the potential role of baseline blood eosinophil counts in identifying patients with chronic rhinosinusitis with nasal polyps (CRSwNP) who are more likely to benefit from biologic therapies.
Current clinical guidelines advocate targeting type 2 inflammation when considering biologics for CRSwNP. While blood eosinophils are widely used as a marker of this inflammatory pathway, their ability to forecast treatment response has remained uncertain—until now. Hence, this study was designed to bridge this gap. PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (Central), and ClinicalTrials.gov were searched to identify eligible studies.
Primary outcomes included nasal polyp score (NPS), nasal congestion score (NCS), the 22-item sino-nasal outcome test (SNOT-22), and loss-of-smell (LoS) score. Subgroup analyses were performed based on baseline blood eosinophil thresholds (<150, ≥150, and ≥300 cells/µL). Overall, 9 studies comprising 10 RCTs with 2,551 participants were included. Biologic therapy remarkably improved NPS, NCS, SNOT-22, and LoS scores compared with placebo across the overall CRSwNP population.
However, patients with baseline eosinophil counts ≥150 cells/µL and ≥300 cells/µL experienced significantly greater reductions in NPS and congestion scores than those with counts <150 cells/µL (p < 0.05). Improvements in SNOT-22 and smell scores were similar across eosinophil groups. Exploratory analyses suggested that in patients with eosinophil ≥300 cells/µL, anti-interleukin-4 receptor alpha (anti-IL-4Rα) monoclonal antibodies elicited greater improvements in NPS and NCS than anti-IL-5 therapies.
Biologic therapies improved clinical outcomes in CRSwNP overall, but patients with baseline eosinophil counts ≥150 cells/µL showed stronger reductions in nasal polyps and congestion. The findings suggested that baseline eosinophil levels may serve as a practical biomarker to identify patients most likely to benefit from biologic therapy and support more personalized treatment strategies.
Clinical Reviews in Allergy & Immunology
Baseline Blood Eosinophil Count for Identifying Superior Responders to Biologics in Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review and Meta-Analysis
Yang Zheng et al.
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