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The following is a summary of “Real-world comparison of T2-biologics effectiveness in severe allergic asthma with nasal polyps,” published in the March 2025 issue of Lung Cancer by Tiotiu et al.

Severe allergic asthma (SAA) is frequently associated with nasal polyps (NP), and patients with blood eosinophil counts ≥0.3 × 10⁹/L are eligible for multiple biological therapies. While biologics targeting IgE, IL-5/IL-5R, and IL-4R have demonstrated efficacy in managing both asthma and NP, direct comparative studies evaluating their effectiveness in patients with coexisting SAA and NP remain scarce. This study aimed to assess and compare the real-world effectiveness of anti-IgE, anti-IL-5/R, and anti-IL-4R biologics in this patient population. A multicenter, real-world observational study was conducted, including patients diagnosed with SAA and NP who received biologic therapy for a minimum of six months. Treatment effectiveness was evaluated by assessing nasal and respiratory symptoms, asthma attack frequency, salbutamol use per week, acute sinusitis episodes, severe exacerbation rates, asthma control scores, pulmonary function parameters, NP endoscopic scores, sinus imaging findings, and blood eosinophil levels, both before and after treatment. 

A total of 107 patients were included, with 35 receiving anti-IgE, 38 receiving anti-IL-5/R, and 34 receiving anti-IL-4R. All three biologic classes demonstrated significant and comparable improvements in asthma-related outcomes, including symptom reduction, lower exacerbation rates, better asthma control, and enhanced lung function. Similarly, all biologics contributed to improvements in nasal symptoms and sinus imaging parameters. However, anti-IL-4R therapy provided superior benefits in specific nasal symptoms, particularly in improving olfactory function ([OR] 3.64, 95% [CI] 1.3–11.1, p = 0.017), reducing nasal obstruction (OR 12.00, 95% CI 2.00–23.10, p = 0.023), and significantly decreasing NP endoscopic scores (OR 18.10, 95% CI 4.43–24.50). 

These findings suggest that while all three biologic classes effectively improve both asthma and sino-nasal outcomes in patients with SAA and NP, anti-IL-4R therapy may provide superior benefits in addressing NP-related symptoms. Further large-scale comparative studies are required to validate these results and refine treatment strategies for patients with coexisting severe asthma and nasal polyps.

Source: resmedjournal.com/article/S0954-6111(25)00041-1/abstract