OBJECTIVES: It is unclear how biologics are incorporated into the current management of chronic rhinosinusitis with nasal polyps (CRSwNP), especially when compared to surgical options for recalcitrant cases. This study aims to investigate treatment patterns and related healthcare-resource utilization (HCRU) in real world settings, with a focus on biologics and surgeries for CRSwNP.

METHODS: We retrospectively reviewed patients who were treated for CRSwNP between June 2019 and July 2020 using Mount Sinai electronic health records (EHRs). Patients who were 18 years or older at the time of recent diagnosis were included. The biologics approved for CRSwNP in the study period were included.

RESULTS: Among 1,399 CRSwNP patients in the study, 224 were treated with biologics or sinus surgeries. Dupilumab, approved for CRSwNP in June 2019, was the only available biologics for CRSwNP in the study period. Compared to those who were treated with surgeries alone (n = 185), patients who used biologics (n = 39) had a higher prevalence of asthma (85% vs. 37%, p: < 0.001), sleep apnea (23% vs. 7%, p: 0.005), and were more likely to have a high eosinophil count (i.e., ≥ 500 cells/mcL) (31% vs. 8%, p: < 0.001). Patients treated with surgeries alone were nearly four times more likely to have outpatient visits for chronic rhinosinusitis after treatment (OR: 3.9; 95% CI: 1.7-9.1; p: 0.001) when compared to the users of biologics. This association remained significant after adjustment for asthma, sleep apnea and high eosinophil count. No significant differences were found for emergency room or inpatient visits after treatment.

CONCLUSIONS: The clinical features of CRSwNP patients who were prescribed biologics were significantly different from those who were treated with surgeries alone. HCRU should be considered in evaluating cost and effectiveness of biologics when compared to conventional treatments in future studies.