BIOLOGIC THERAPY AND QUALITY OF LIFE IN NSAID-EXACERBATED RESPIRATORY DISEASE: A SYSTEMATIC REVIEW OF SNOT-22 PATIENT-REPORTED OUTCOMES
DOI:
https://doi.org/10.31435/ijitss.1(49).2026.5420Keywords:
NSAID-Exacerbated Respiratory Disease (N-ERD), Aspirin-Exacerbated Respiratory Disease (AERD), Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), Biologics, Dupilumab, Mepolizumab, SNOT-22, Quality of LifeAbstract
Background: Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) is a severe, refractory phenotype of chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma. Traditional treatments, including repeated endoscopic sinus surgeries and aspirin therapy after desensitization (ATAD), are frequently limited by high recurrence and discontinuation rates, leaving a critical unmet need for durable symptom control.
Objective: To systematically evaluate the impact of targeted biologic therapies on patient-reported quality of life in the N-ERD population, utilizing the 22-item Sino-Nasal Outcome Test (SNOT-22).
Methods: A systematic literature search of PubMed and Scopus was conducted between January and March 2026. Eligibility criteria strictly isolated studies reporting longitudinal, continuous SNOT-22 data for adult N-ERD cohorts treated with monoclonal antibodies.
Results: Eight studies met the inclusion criteria. Pre-treatment SNOT-22 scores confirmed severe baseline disability across all cohorts.Treatment with the anti-IL-4Rα agent dupilumab rapidly transformed patient outcomes, yielding clinically meaningful SNOT-22 score reductions ranging from 27 to 48 points, which were sustained for up to two years.Dupilumab demonstrated robust efficacy in restoring olfactory function and improving asthma control. While anti-IL-5 therapies (mepolizumab) provided clinical benefit, comparative data indicated they were less consistently effective at normalizing olfaction and achieving comprehensive symptom resolution than dupilumab.
Conclusion: Targeted biologic therapies, particularly dupilumab, deliver significant improvements in quality of life for patients with N-ERD. They represent a highly effective, non-surgical step-up therapy capable of halting the surgical cycle and achieving profound symptom relief in treatment-refractory patients.
References
Achanta, P. M., Swirnoff, J., Parigian, R. E., Laidlaw, T. M., & Buchheit, K. M. (2025). Addition of dupilumab for patients with aspirin-exacerbated respiratory disease who have poor response to aspirin therapy after desensitization. The Journal of Allergy and Clinical Immunology: In Practice, 13(12), 3425–3427.e1. https://doi.org/10.1016/j.jaip.2025.08.032
Bachert, C., Sousa, A. R., Han, J. K., Schlosser, R. J., Sowerby, L. J., Hopkins, C., Maspero, J. F., Smith, S. G., Kante, O., Karidi-Andrioti, D. E., Mayer, B., Chan, R. H., Yancey, S. W., & Chaker, A. M. (2022). Mepolizumab for chronic rhinosinusitis with nasal polyps: Treatment efficacy by comorbidity and blood eosinophil count. Journal of Allergy and Clinical Immunology, 149(5), 1711–1721.e6. https://doi.org/10.1016/j.jaci.2021.10.040
Barroso, B., Valverde-Monge, M., Alobid, I., Olaguibel, J. M., Rial, M. J., Quirce, S., Arismendi, E., Barranco, P., Betancor, D., Bobolea, I., Cárdaba, B., Cruz Carmona, M. J., Curto, E., Dominguez-Ortega, J., González-Barcala, F. J., Martinez-Rivera, C., Mahillo-Fernández, I., Muñoz, X., Picado, C., Plaza, V., Rodrigo Muñoz, J. M., Soto-Retes, L., Valero, A., del Pozo, V., Mullol, J., & Sastre, J. (2023). Improvement in olfaction in patients with CRSwNP and severe asthma taking anti-IgE and anti-IL-5 biologics: A real-life study. Journal of Investigational Allergology and Clinical Immunology, 33(1), 37–44. https://doi.org/10.18176/jiaci.0812
Bavaro, N., Gakpo, D., Mittal, A., Bensko, J. C., Laidlaw, T. M., & Buchheit, K. M. (2021). Efficacy of dupilumab in patients with aspirin-exacerbated respiratory disease and previous inadequate response to anti-IL-5 or anti-IL-5Rα in a real-world setting. The Journal of Allergy and Clinical Immunology: In Practice, 9(7), 2910–2912.e1. https://doi.org/10.1016/j.jaip.2021.02.020
Bertlich, M., Ihler, F., Bertlich, I., Weiss, B. G., Gröger, M., & Haubner, F. (2021). Management of chronic rhinosinusitis with nasal polyps in Samter triad by low-dose ASA desensitization or dupilumab. Medicine, 100(40), e27471. https://doi.org/10.1097/MD.0000000000027471
Bertlich, M., Freytag, S., Dombrowski, T., Jurmeister, P., Spiegel, J. L., Bertlich, I., Ihler, F., Weiss, B. G., Haubner, F., & Gröger, M. (2022). Subgroups in the treatment of nasal polyposis with dupilumab: A retrospective study. Medicine, 101(45), e31031. https://doi.org/10.1097/MD.0000000000031031
Brkic, F. F., Liu, D. T., Klimbacher, R., Campion, N. J., Bartosik, T. J., Vyskocil, E., Stanek, V., Tu, A., Arnoldner, T., Bangert, C., Gangl, K., Eckl-Dorna, J., & Schneider, S. (2023). Efficacy and safety of switching between biologics in chronic rhinosinusitis with nasal polyps or N-ERD. Rhinology Journal, 61(4), 320–327. https://doi.org/10.4193/Rhin22.408
Buchheit, K. M., Sohail, A., Hacker, J., Maurer, R., Gakpo, D., Bensko, J. C., Taliaferro, F., Ordovas-Montanes, J., & Laidlaw, T. M. (2022). Rapid and sustained effect of dupilumab on clinical and mechanistic outcomes in aspirin-exacerbated respiratory disease. Journal of Allergy and Clinical Immunology, 150(2), 415–424. https://doi.org/10.1016/j.jaci.2022.04.007
Çelik Tuğlu, H., Aksu, K., Telli, O., Dindar Çelik, F., Yağdıran, M., Akkale, Ö., Köycü Buhari, G., Bahçecioğlu, S. N., & Vural Solak, G. T. (2025). The effect of biological agent use on symptoms in patients diagnosed with NSAID-exacerbated respiratory disease (NERD). Revue Française d’Allergologie, 65(4), 104219. https://doi.org/10.1016/j.reval.2024.104219
Chen, C. C., Buchheit, K. M., Lee, P. Y., Brodeur, K. E., Sohail, A., Cho, L., Baloh, C. H., Balestrieri, B., Derakhshan, T., Feng, C., Boyce, J. A., Dwyer, D. F., & Laidlaw, T. M. (2024). IL-4Rα signaling promotes barrier-altering oncostatin M and IL-6 production in aspirin-exacerbated respiratory disease. Journal of Allergy and Clinical Immunology, 154(2), 458–467.e3. https://doi.org/10.1016/j.jaci.2024.04.020
Domínguez-Sosa, M. S., Cabrera-Ramírez, M. S., Marrero-Ramos, M. D. C., Dávila-Quintana, D., Cabrera-López, C., Carrillo-Díaz, T., & Del Rosario, J. J. B. (2023). Real-life effectiveness of mepolizumab in refractory chronic rhinosinusitis with nasal polyps. Biomedicines, 11(2), 485. https://doi.org/10.3390/biomedicines11020485
Elzinga, H. B. E., Otten, J. J., Cornet, M. E., Rinia, A. B., Van Der Lans, R. J. L., Fokkens, W. J., Reitsma, S., & PolyREG Consortium. (2025). Two‐year data of tapered dupilumab shows high effectiveness in chronic rhinosinusitis with nasal polyps with nonsteroidal anti‐inflammatory drug‐exacerbated respiratory disease. Allergy, 80(6), 1737–1745. https://doi.org/10.1111/all.16579
Foerster-Ruhrmann, U., Jurkov, M., Szczepek, A. J., Bergmann, K.-C., Fluhr, J. W., & Olze, H. (2024). Biologics reduce symptoms of alcohol intolerance better than aspirin desensitization in patients with N-ERD and nasal polyps. Biomedicines, 12(5), 1025. https://doi.org/10.3390/biomedicines12051025
Fokkens, W. J., Viskens, A.-S., Backer, V., Conti, D., De Corso, E., Gevaert, P., Scadding, G. K., Wagemann, M., Bernal-Sprekelsen, M., Chaker, A., Heffler, E., Han, J. K., Van Staeyen, E., Hopkins, C., Mullol, J., Peters, A., Reitsma, S., Senior, B. A., & Hellings, P. W. (2023). EPOS/EUFOREA update on indication and evaluation of biologics in chronic rhinosinusitis with nasal polyps 2023. Rhinology Journal, 0(0). https://doi.org/10.4193/Rhin22.489
Galletti, C., Ragusa, M., Sireci, F., Ciodaro, F., Barbieri, M. A., Giunta, G., Grigaliute, E., Immordino, A., Lorusso, F., Dispenza, F., Freni, F., Galletti, F., Gallina, S., La Mantia, I., & Galletti, B. (2024). Dupilumab in chronic rhinosinusitis with nasal polyps: Real life data in a multicentric Sicilian experience. American Journal of Otolaryngology, 45(1), 104106. https://doi.org/10.1016/j.amjoto.2023.104106
Garvey, E., Naimi, B., Duffy, A., Hannikainen, P., Kahn, C., Farquhar, D., Rosen, M., Rabinowitz, M., Toskala, E., & Nyquist, G. (2024). Optimizing the timing of biologic and surgical therapy for patients with refractory chronic rhinosinusitis with nasal polyposis (CRSwNP). International Forum of Allergy & Rhinology, 14(3), 651–659. https://doi.org/10.1002/alr.23246
Grose, E., Li, A. Y., & Lee, J. M. (2023). Clinical outcomes of dupilumab therapy in chronic rhinosinusitis with nasal polyps in a Canadian tertiary care rhinology practice. Allergy, Asthma & Clinical Immunology, 19(1), 26. https://doi.org/10.1186/s13223-023-00782-7
Hayashi, H., Fukutomi, Y., Mitsui, C., Kajiwara, K., Watai, K., Tomita, Y., Kamide, Y., Tsuburai, T., Sekiya, K., Ishii, M., Hasegawa, Y., & Taniguchi, M. (2023). Omalizumab ameliorates extrarespiratory symptoms in patients with aspirin-exacerbated respiratory disease. Journal of Allergy and Clinical Immunology, 151(6), 1667–1672.e2. https://doi.org/10.1016/j.jaci.2023.03.014
Imam, K. H., & Woessner, K. M. (2023). Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease: Diagnosis and current management. Polish Archives of Internal Medicine. https://doi.org/10.20452/pamw.16544
Kumar, N., Pace, T., Gomes, P. L., Marino, M. J., Miglani, A., & Lal, D. (2026). Real‐world treatment patterns in AERD: An analysis of ATAD, biologics, and combination therapy. International Forum of Allergy & Rhinology, 16(1), 99–101. https://doi.org/10.1002/alr.70072
Laidlaw, T. M. (2025). Aspirin-exacerbated respiratory disease in the era of biologics. Annals of Allergy, Asthma & Immunology, 135(4), 366–373. https://doi.org/10.1016/j.anai.2025.06.001
Lázaro-Sastre, M., Moreno-Rodilla, E., Martín-García, C., Maza-Solano, J., Gil-Melcon, M., & Dávila, I. (2026). A systematic review of the specific role of biological therapies in aspirin-exacerbated respiratory disease. Journal of Investigational Allergology and Clinical Immunology, 36(1), 12–24. https://doi.org/10.18176/jiaci.1155
Ley-Tomas, J. J., Xicotencatl-Tellez, A. M., García-Cruz, M. L., & Jiménez-Chobillon, M. A. (2024). Nonsteroidal antiinflammatory drug-exacerbated respiratory disease: Molecular mechanism, management and treatment. Frontiers in Allergy, 5, 1462985. https://doi.org/10.3389/falgy.2024.1462985
Lyly, A., Laulajainen‐Hongisto, A., Turpeinen, H., Vento, S. I., Myller, J., Numminen, J., Sillanpää, S., Sahlman, J., Kauppi, P., & Toppila‐Salmi, S. (2021). Factors affecting upper airway control of NSAID‐exacerbated respiratory disease: A real‐world study of 167 patients. Immunity, Inflammation and Disease, 9(1), 80–89. https://doi.org/10.1002/iid3.347
Lyly, A., Sahlman, J., Pajala, K., Salminen, M., Sillanpää, S., Numminen, J., Hanif, T., Laulajainen-Hongisto, A., Mäkelä, M., Kauppi, P., Kangasniemi, I., Lilja, M., Hammaren-Malmi, S., Virkkula, P., & Toppila-Salmi, S. (2025). Study protocol for a randomized double-blinded placebo-controlled trial on mepolizumab for patients with chronic rhinosinusitis with nasal polyps, NSAID exacerbated respiratory disease and asthma. Frontiers in Allergy, 6, 1568081. https://doi.org/10.3389/falgy.2025.1568081
Matsumoto-Sasaki, M., Simizu, K., Suzuki, M., Suzuki, M., Kimura, H., Nakamaru, Y., Ito, Y. M., Homma, A., & Konno, S. (2022). Clinical characteristics of patients and factors associated with switching biologics in asthma. Journal of Asthma and Allergy, 15, 187–195. https://doi.org/10.2147/JAA.S348513
Mieli, O. M., Valera, F. C. P., Dinarte, V. R. P., De Lima, C. M. F., Nakanishi, M., Zanetti, M. E. T., Pires, F. O., Garcia, D. M., Murashima, A. D. A. B., Arruda, L. K. D. P., Romano, F. R., Lemos, J. E. S., Kosugi, E. M., Sakano, E., Tepedino, M. S., Tamashiro, E., & Anselmo-Lima, W. T. (2025). One-year efficacy of dupilumab in sense of smell, nasal polyp score and quality of life in CRSwNP patients: A real-world multicenter study in Brazil. Brazilian Journal of Otorhinolaryngology, 91(6), 101704. https://doi.org/10.1016/j.bjorl.2025.101704
Mullol, J., Fokkens, W. J., Smith, S. G., Keeley, T., Zhang, L., Howarth, P., Chan, R. H., & Bachert, C. (2024). The impact of mepolizumab on sleep impairment in CRSwNP: Post hoc analyses of SYNAPSE and MUSCA. Rhinology Journal, 0(0), 0–0. https://doi.org/10.4193/Rhin24.021
Mullur, J., Steger, C. M., Gakpo, D., Bensko, J. C., Maurer, R., Laidlaw, T. M., & Buchheit, K. M. (2022). Aspirin desensitization and biologics in aspirin-exacerbated respiratory disease. Annals of Allergy, Asthma & Immunology, 128(5), 575–582. https://doi.org/10.1016/j.anai.2022.01.043
Mullur, J., & Buchheit, K. M. (2023). Aspirin-exacerbated respiratory disease. Annals of Allergy, Asthma & Immunology, 131(3), 317–324. https://doi.org/10.1016/j.anai.2023.05.016
Mullur, J., Lundberg, M., Maurer, R., Laidlaw, T. M., & Buchheit, K. M. (2024). Dupilumab rapidly improves eustachian tube dysfunction and otologic symptoms in aspirin-exacerbated respiratory disease. Allergy and Asthma Proceedings, 45(6), 421–425. https://doi.org/10.2500/aap.2024.45.240047
Ozuna, L., Ryan, T., Bensko, J. C., Laidlaw, T. M., & Buchheit, K. M. (2022). Dupilumab-associated arthralgia in patients with aspirin-exacerbated respiratory disease. Annals of Allergy, Asthma & Immunology, 128(4), 469–472. https://doi.org/10.1016/j.anai.2022.01.036
Patel, P., Bensko, J. C., Bhattacharyya, N., Laidlaw, T. M., & Buchheit, K. M. (2022). Dupilumab as an adjunct to surgery in patients with aspirin-exacerbated respiratory disease. Annals of Allergy, Asthma & Immunology, 128(3), 326–328. https://doi.org/10.1016/j.anai.2021.11.020
Schneider, S., Poglitsch, K., Morgenstern, C., Quint, T., Gangl, K., Sinz, C., Bartosik, T., Campion, N. J., Liu, D. T., Landegger, L. D., Tu, A., Stanek, V., Rocha-Hasler, M., Bangert, C., & Eckl-Dorna, J. (2023). Dupilumab increases aspirin tolerance in NSAID-exacerbated respiratory disease. European Respiratory Journal, 61(3), 2201335. https://doi.org/10.1183/13993003.01335-2022
Stevens, W. W., & Cahill, K. N. (2023). Mechanistic and clinical updates in AERD: 2021-2022. Journal of Allergy and Clinical Immunology, 151(6), 1448–1456. https://doi.org/10.1016/j.jaci.2023.03.015
Supron, A. D., Bergmark, R. W., Roditi, R. E., & Buchheit, K. M. (2023). Perioperative mepolizumab in aspirin-exacerbated respiratory disease does not prevent nasal polyp regrowth. Annals of Allergy, Asthma & Immunology, 131(3), 384–386. https://doi.org/10.1016/j.anai.2023.06.017
Tepetam, F. M., Özden, Ş., Kılıç, F. K., Örçen, C., & Yakut, T. (2023). Does NSAID exacerbated respiratory disease (N-ERD) accompanying severe asthma affect biological treatment response? Efficacy of omalizumab and mepolizumab in N-ERD. World Allergy Organization Journal, 16(9), 100817. https://doi.org/10.1016/j.waojou.2023.100817
Van Broeck, D., Steelant, B., Scadding, G., & Hellings, P. W. (2023). Monoclonal antibody or aspirin desensitization in NSAID-exacerbated respiratory disease (N-ERD)? Frontiers in Allergy, 4, 1080951. https://doi.org/10.3389/falgy.2023.1080951
Wangberg, H., Spierling Bagsic, S. R., Osuna, L., & White, A. A. (2022). Appraisal of the real-world effectiveness of biologic therapies in aspirin-exacerbated respiratory disease. The Journal of Allergy and Clinical Immunology: In Practice, 10(2), 478–484.e3. https://doi.org/10.1016/j.jaip.2021.09.030
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Copyright (c) 2026 Alicja Laske , Antoni Majda, Natalia Sitko , Paulina Makowska , Joanna Gontarczyk , Martyna Sowa, Julia Pająk, Kacper Kucharski , Anna Kamosińska , Adam Kowal, Julia Sokołowska, Marcel Dawidowicz
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