With the increasing recognition of the role of type 2 immune responses in chronic rhinosinusitis, its severity, recurrence, and comorbidities, several biologics targeting IL-4, IL-5, and IL-13 as well as IgE have been administered in small proof-of-concept studies. Recently, the first phase 3 trials have been reported with dupilumab, an IL-4 receptor antagonist, demonstrating a significant and clinically relevant reduction of the disease burden from polyp size and sinus involvement to symptoms and smell; these changes consecutively led to an important increase in quality of life. Finally, the biologic versus placebo treatment reduced the need for systemic glucocorticosteroids and sinus surgery significantly and clinically meaningfully. Dupilumab today is registered for the treatment of chronic rhinosinusitis with nasal polyps in Europe and the United States. Within a year, 2 further phase 3 trials with omalizumab and mepolizumab will be reported. With this development, without any doubt, a new era for the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps has begun. Questions on the indication of the biologics, the selection of patients, and finally criteria for monitoring the efficacy in individual patients need to be urgently answered, and care pathways need to be established integrating the current standard of care including surgery.

随着人们越来越认识到2型免疫应答在慢性鼻-鼻窦炎中的作用，其严重性，复发和合并症，已针对小分子证据施用了针对IL-4，IL-5和IL-13以及IgE的几种生物制剂，概念研究。最近，已经报道了IL-4受体拮抗剂dupilumab的第一个3期试验，表明从息肉大小和鼻窦受累到症状和嗅觉，疾病负担显着降低并在临床上具有相关意义。这些变化连续导致生活质量的重要提高。最后，生物治疗与安慰剂治疗显着且临床上有意义地减少了对全身糖皮质激素和鼻窦手术的需求。今天，Dupilumab已在欧洲和美国注册用于治疗具有鼻息肉的慢性鼻-鼻窦炎。在一年之内，将报告另外2项使用omalizumab和mepolizumab进行的3期试验。毫无疑问，随着这种发展，鼻息肉治疗严重的不受控制的慢性鼻鼻窦炎的新时代已经开始。需要紧急回答有关生物制剂的适应症，患者的选择以及最终监测单个患者疗效的标准的问题，并且需要建立结合包括手术在内的当前护理标准的护理途径。鼻息肉治疗严重的不受控制的慢性鼻-鼻窦炎的新时代已经开始。需要紧急回答有关生物制剂的适应症，患者的选择以及最终监测单个患者疗效的标准的问题，并且需要建立结合包括手术在内的当前护理标准的护理途径。鼻息肉治疗严重的不受控制的慢性鼻-鼻窦炎的新时代已经开始。需要紧急回答有关生物制剂的适应症，患者的选择以及最终监测单个患者疗效的标准的问题，并且需要建立结合包括手术在内的当前护理标准的护理途径。