Surgery and/or biologics in chronic rhinosinusitis with nasal polyps: EUFOREA/EPOS consensus paper

Optimizing Treatment Strategies for Chronic Rhinosinusitis with Nasal Polyps

The treatment landscape for chronic rhinosinusitis with nasal polyps (CRSwNP) has evolved significantly with the introduction of biologic therapies. While endoscopic sinus surgery (ESS) and biologics have both demonstrated efficacy, questions remain about their optimal sequencing, timing, and role in the management of patients with severe disease.

To address these challenges, an international multidisciplinary panel of experts from EUFOREA and EPOS reviewed evidence from clinical trials, real-world studies, and current guidelines to establish a consensus on the indications, timing, and therapeutic positioning of surgery and biologics in CRSwNP.

The resulting consensus provides key definitions and clinical criteria to support a unified, evidence-based approach to treatment. Among its recommendations, the expert panel emphasizes that patients with diffuse disease should undergo at least primary complete endoscopic sinus surgery. It also advises against initiating surgery and biologic therapy simultaneously, given the current evidence, and reinforces existing criteria for selecting patients for biologic treatment.

Furthermore, the consensus highlights the limitations of long-term systemic corticosteroid use, particularly when biologic therapies are available. By clarifying how surgery and biologics can complement each other, this EUFOREA/EPOS initiative aims to support personalized treatment decisions and improve outcomes for patients across the airway continuum.