Global airways: a Danish nationwide real-life registry of biologic therapy for chronic rhinosinusitis with nasal polyps

TL;DR

A Danish registry tracked biologic therapy outcomes for chronic rhinosinusitis with nasal polyps over a year, showing significant improvements in patient symptoms.

Contribution

The Global Airways registry provides real-world data on biologic therapy effectiveness for chronic rhinosinusitis with nasal polyps.

Findings

Biologic therapy significantly improved symptoms like nasal polyp scores and asthma control over 12 months.

The registry effectively collected longitudinal data, supporting the use of biologics in refractory cases.

Patients showed sustained improvement in quality of life and nasal function metrics.

Abstract

The relationship between chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and type 2 inflammation has led to the use of biologic treatment for uncontrolled cases. As biologic treatment remains a relatively new approach for CRSwNP, systematic assessment and collection of high-quality, real-world data are crucial. This study established the national Global Airways registry to collect longitudinal data over a period of 12 months for patients with CRSwNP treated with biological therapies according to criteria established by the Danish Health Authority.

All participating sites conducted systematic assessments of patients with CRSwNP referred for initiation of biologic treatment. Clinical and patient-reported outcome data were collected at baseline and after 6 and 12 months of treatment and were entered in real-time into the Global Airways registry. Comparisons were performed between patients eligible or not eligible for biologic therapy and between pre- and post-treatment timepoints.

A total of 513 patients were enrolled between November 2022 and December 2024, with 310 receiving treatments with biologics (mepolizumab or dupilumab). Mean [standard deviation (SD)] age in the treatment group was 49.7 (14) years and 66% were male. The median number of previous endoscopic sinus surgeries was 2 (range 1–16). Baseline mean (SD) scores were as follows: Nasal Polyp Score (NPS) 4.8 (1.7); Sinonasal Outcome Test (SNOT)-22 68.7 (18.7); Visual Analog Scale (VAS) CRS 84.1 (16); and Sniffin’ Sticks-16 (SST-16) score 4.8 (3). Asthma was present in 204 (66%) patients, with a mean (SD) Asthma Control Questionnaire (ACQ)-5 score of 2.1 (1.5). Among patients with available data at both 6 and 12 months (n = 160), mean SNOT-22 scores improved from 68 to 29 and 24, NPS from 5.1 to 3.0 and 2.4, SST-16 from 4.7 to 9.2 and 10.0, and ACQ-5 from 2.3 to 1.0 and 0.8 (all p < 0.001).

The Global Airways registry was an effective working tool that ensured collection of important real-world data when moving from surgery to biologics. Furthermore, the registry demonstrated the sustained effectiveness of biologic therapy in patients with refractory CRSwNP and provided a robust foundation for defining CRS phenotypes and advancing targeted treatment strategies.

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