Sinus Surgery and Biologics in CRSwNP: The New Goal Is Remission, Not Just Relief
Remission in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP): Why “Feeling Better” Is No Longer Enough
For years, success in chronic rhinosinusitis with nasal polyps (CRSwNP) meant one thing: the patient feels better.
But in 2025, that is no longer our goal.
With the arrival of biologic therapies for nasal polyps—including dupilumab, mepolizumab, and benralizumab—the target has shifted. In other airway diseases, especially asthma, the conversation has moved beyond symptom improvement toward a more ambitious endpoint: remission. Severe asthma remission has been defined as a composite state (no exacerbations, no systemic corticosteroids, sustained symptom control, stable objective measures, over time).(1) Real-world studies show that remission is achievable in a meaningful subset of biologic-treated asthma patients.(2,3)
CRSwNP shares overlapping type 2 inflammatory biology with asthma and responds to targeted biologics.(4–7) So the obvious question is:
Should we aim for remission in nasal polyps too?
The answer is yes—but CRS is structurally different.
Why Sinus Surgery Changes the Remission Conversation
Unlike asthma, we can surgically modify the anatomy in CRSwNP.
Procedures such as complete sphenoethmoidectomy and extended surgery (e.g., Draf IIc/III) reshape the inflammatory environment, improve topical access, and reduce persistent diseased compartments.(8–10) Distribution studies demonstrate that extended frontal procedures can improve irrigation penetration compared with more limited frontal approaches.(9)
Recent evidence also shows that surgical completeness predicts disease trajectory and may influence response to subsequent biologic therapy. CT-based measures of completeness such as ACCESS (Amsterdam Classification of Completeness of Endoscopic Sinus Surgery) quantify how complete surgery is and have been linked to outcomes.(11) Similarly, the Completion of Surgery Index (CoSI) provides another structured approach to capturing adequacy of surgical extent.(12)
Our recent study—Extent of sinus surgery is associated with disease control in biologic treated type-2 dominant CRS—found that extended neo-sinuis surgery was strongly associated with achieving disease control in biologic-treated patients.(13) Clincial remisison achieved in 60%+ of patients.
In other words: surgical completeness matters.
So remission in CRSwNP cannot be defined by symptoms alone.
CRSwNP Remission vs. Symptom Improvement
Traditionally, studies report:
Change in SNOT-22
Change in polyp score
Corticosteroid use
Avoidance of revision surgery
These are essential metrics and remain central in consensus guidance.(14,15) But they measure improvement, not a stable disease state.
A patient can be polyp-free yet still require repeated systemic corticosteroids. That is not remission.
That is partial control.
Partial control in nasal polyps
What Should Remission in Nasal Polyps Look Like?
A practical remission framework for CRSwNP should include multiple domains, similar to other inflammatory diseases:
Complete Clinical Remission (≥12 months)
SNOT-22
