TOPLINE:

Biologic therapies may vary in their ability to improve olfactory function in adults with chronic rhinosinusitis with nasal polyps (CRSwNP), according to a meta-analysis. Among the biologics analyzed, dupilumab improved smell the most.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of 28 studies, including eight randomized controlled trials (n = 2024) and 20 observational cohort studies (n = 1685), to examine the effect of biologic therapies on restoration of smell in patients with CRSwNP.
• They analyzed six biologics in randomized controlled trials: dupilumab (n = 4), omalizumab (n = 2), mepolizumab (n = 1), benralizumab (n = 1), tezepelumab (n = 1), and telikibart (n = 1).
• The primary outcome was the mean change in olfactory test scores measured using validated psychophysical instruments including the University of Pennsylvania Smell Identification Test (UPSIT).

TAKEAWAY:

• Across all trials, biologic therapies had a moderate-to-large treatment effect on smell scores, with a pooled standardized mean difference (SMD) of 0.72 (P = .0004).
• In studies using UPSIT scores, the use of biologic therapy was linked to a mean improvement of 7.37 points on this measure (95% CI, 4.6-10.1; P < .0001).
• In a pooled subgroup analysis, dupilumab had the strongest effect in improving smell (SMD, 1.16; 95% CI, 0.35-1.97), followed by benralizumab (SMD, 1.03; 95% CI, 0.55-1.51), whereas the effect of mepolizumab was not statistically significant.

IN PRACTICE:

“The restoration of olfaction should be recognized as a central outcome of biologic therapy in CRSwNP patients and integrated into both clinical practice and guideline development,” the authors of the study wrote.

SOURCE:

This study was led by Christian K. Pedersen, PhD, and Vibeke Backer, MD, with the University of Copenhagen, Copenhagen, Denmark. It was published online on November 20, 2025, in Current Allergy and Asthma Reports.

LIMITATIONS:

The study was limited by heterogeneity in patient populations and outcome measures across studies. All but one of the cohort studies focused on dupilumab. Most trials did not follow participants for more than a year.

DISCLOSURES:

The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.