The emerging role of anti-thymic stromal lymphopoietin monoclonal antibody (Tezepelumab) in comorbid and non-comorbid CRSwNP patients: a scoping review

TL;DR

Tezepelumab, a new drug, effectively treats nasal polyps and related symptoms, even in patients with asthma, reducing the need for steroids and surgery.

Contribution

This study is the first to systematically review Tezepelumab's effectiveness in both comorbid and non-comorbid CRSwNP patients.

Findings

Tezepelumab significantly reduces nasal congestion and loss of smell in CRSwNP patients.

The drug lowers the need for corticosteroids and surgery in patients with nasal polyps.

Improvements in lung function were observed in patients with comorbid asthma.

Abstract

•Tezepelumab improves CRSwNP symptoms and polyp burden.•Tezepelumab reduces nasal congestion and loss of smell in CRSwNP.•Tezepelumab is effective in patients with CRSwNP and comorbid asthma.•Tezepelumab lowers systemic corticosteroid and surgical needs.•Tezepelumab targets upstream inflammation, including T2 and non-T2 types.

Tezepelumab improves CRSwNP symptoms and polyp burden.

Tezepelumab reduces nasal congestion and loss of smell in CRSwNP.

Tezepelumab is effective in patients with CRSwNP and comorbid asthma.

Tezepelumab lowers systemic corticosteroid and surgical needs.

Tezepelumab targets upstream inflammation, including T2 and non-T2 types.

This systematic review aims to evaluate the effectiveness of Tezepelumab, a monoclonal antibody targeting the thymic stromal lymphopoietin, in patients affected by chronic rhinosinusitis with nasal polyposis, both with and without comorbid asthma.

A systematic search of the literature was conducted across PubMed, SCOPUS, and Google Scholar databases until April 2025. Studies were selected based on predefined inclusion criteria, focusing on adult patients with clinically diagnosed chronic rhinosinusitis with nasal polyps who received Tezepelumab treatment for at least four weeks and reported validated clinical outcomes. Studies involving patients receiving prior standard treatment and comorbid asthma were included. Outcome measures included sinonasal symptom scores, imaging scores, pulmonary function tests, quality of life assessments, systemic corticosteroid use, and the need for surgical intervention. Study selection, data extraction, and quality assessment were conducted independently by two reviewers.

Out of 221 screened records, three randomized controlled trials involving a total of 691 patients met the eligibility criteria. Tezepelumab treatment resulted in significant improvements in nasal symptom scores, including reductions in nasal congestion and loss of smell, as well as improved quality of life and sleep-related symptoms. Objective assessments showed a reduction in polyp size and radiological scores, with fewer patients requiring systemic corticosteroids or surgical intervention compared to placebo. Improvements were also observed in lung function and disease control among patients with comorbid asthma. The effect size exceeded minimal clinically important difference thresholds across key outcome measures.

Tezepelumab demonstrated consistent and clinically meaningful benefits in the treatment of chronic rhinosinusitis with nasal polyps, including symptom relief, reduced polyp burden, and decreased need for corticosteroids or surgery. Its upstream mechanism offers potential advantages over existing biologic therapies. Further long-term and real-world studies are needed to confirm its role in clinical practice and define ideal patient selection strategies.

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