Clinicians have a new line of weapons in their arsenal to treat recurring nasal polyps. Over the past year several new monoclonal antibody-based biologic drugs have been approved to treat the condition when steroids or surgery fail, by targeting the inflammatory cascade that drives their growth.

Nasal polyps are benign growths on the inside of the nose that resemble bunches of grapes. Although noncancerous, they can block the nasal passages, causing difficulty breathing and sinus infections, and interfere with the sense of smell.

“They’re a little like weeds,” said Amrita Ray, DO, otolaryngologist at Henry Ford Health in Detroit. “Even if we cut them out, they try to come back.”

The conventional treatment for nasal polyps is steroids — either systemic oral steroids, such as prednisone, or topical irrigation with saline with steroids added — to shrink the lesions and surgery to remove them. But for many people these treatments offer only temporary relief, and steroids in particular have several downsides. They can cause short-term side effects such as anxiety and gastrointestinal issues, as well as longer-term ones such as thinning of the hair, bone, and skin. “We can’t keep people on oral steroids at the dose needed” to control polyps over the long term,” Ray said.

So a new tool was very much needed, said Raj Sindwani, MD, otolaryngologist at Cleveland Clinic in Ohio, especially for those whose polyps keep returning. “I have patients walking around having had 8, 9, even 14 surgeries,” he said.

Biologic Breakthrough

The advent of biologics for nasal polyps was serendipitous, Ray said. Most of these drugs were used initially to treat asthma, but clinicians noticed patients who also had polyps saw a significant reduction in their burden when taking the medications. 

“We’re starting to realize that they have a lot of broader implications and effects,” she said.

Several different biologics have now been approved or are under review by the FDA for treating nasal polyps. Mepolizumab from GSK, which had previously been approved to treat eosinophilic asthma, was expanded to include chronic rhinosinusitis with nasal polyps (CRSwNP) in 2021. Dupilumab, first developed by Regeneron and Sanofi Genzyme to treat allergic diseases such as atopic dermatitis and asthma, was approved for CRSwNP in adults in June 2019 and for patients aged 12 or older in September 2024. The approval for tezepelumab (Tezspire), an asthma drug from Amgen and AstraZeneca, was expanded to include CRSwNP in October 2025. And GSK’s depemokimab was accepted for review in March 2025 for asthma and CRSwNP.  

The drugs are delivered by subcutaneous injection, either once or twice a month, although depemokimab only needs to be given every 6 months.

Each drug has a different target. Dupilumab targets interleukin-4, while tezepelumab targets thymic stromal lymphopoietin (TSLP), and both mepolizumab and depemokimab target interleukin-5. But the concept behind each is the same: binding to one of these proteins or their receptors to tamp down one aspect of the inflammatory cascade that drives the growth of polyps.

Alison Church, MD, VP of global development for inflammation at Amgen, said TSLP is a particularly useful target because it controls the inflammatory response across multiple pathways: allergic, eosinophilic, and others. Tezepelumab “targets the top of the inflammatory cascade by binding to TSLP and prevents activation of those multiple downstream inflammatory pathways,” she said.

This focus on managing inflammation has been the “missing piece” in the treatment of nasal polyps, Sindwani said. “When you had a patient whose polyps were going to grow back despite surgery, we had nothing useful to offer them,” he said.

Order of Operations

The main discussion now is over when biologics should be used. All of the drugs have been approved, or are being reviewed, as add-on maintenance therapy for patients whose polyps are not controlled by intranasal corticosteroid wash. Robert Fogel, MD, VP of US Medical Affairs at AstraZeneca, said patients do not have to have failed surgery to get biologics. But most providers reserve them for those who have already had at least one surgery and should not take further oral steroids.

“In practice we do surgery, then use biologics to help hold the fort so the polyps don’t grow back,” Ray said.

That approach is backed by several consensus statements from rhinology and allergy groups, Sindwani said, including ICAR and EPOS/EUPHORIA, which recommend biologics for patients with at least one prior surgery — or those who are not a candidate for surgery — and evidence of type 2 inflammation or comorbid asthma or aspirin-exacerbated respiratory disease. 

The main reason for holding them back: Biologic drugs typically cost around $30,000 to $40,000 per year, Sindwani said, and they are a lifetime commitment; they work only while the patient is taking them, and polyps can return if treatment ends.

“In some rare circumstances we might use biologics before surgery, for instance if there are multiple reasons to take them, such as comorbid asthma that requires biologics,” he said. “But if we can control polyps with one surgery and compliant topical steroids, we don’t need to jump to expensive biologics right away.”

Fogel said the development of biologics has been a major breakthrough for the field, as people often underestimate how severely nasal polyps can affect someone’s quality of life. “They’re not life-threatening, but people often say it’s like having the worst cold of your life, every day of your life,” he said. “So this has been a really important advancement in treatment.”

Editor's note: This article originally included inaccurate information about the approval of dupilumab for CRSwNP.

Ray and Sindwani reported having no relevant financial conflicts of interest. 

Brian Owens is a freelance journalist in New Brunswick, Canada.