Efficacy of tezepelumab in chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis

Purpose: To evaluate the efficacy of tezepelumab as an adjunctive treatment in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: PubMed, SCOPUS, Embase, Web of Science, and the Cochrane Library were systematically searched from database inception through January 2026. Eligible studies compared tezepelumab with placebo or reported pre-post treatment outcomes in tezepelumab-treated cohorts. Outcomes included nasal and olfactory symptom measures (nasal congestion, nasal polyp score, olfactory testing, olfactory-related symptoms, and the Sino-Nasal Outcome Test-22 [SNOT-22]), asthma-related measures (pre-bronchodilator forced expiratory volume in 1 s [FEV₁] and the Asthma Control Questionnaire [ACQ]-6), and treatment-related adverse events. Results: Four studies involving 702 participants met the inclusion criteria. Pre-post analyses demonstrated significant improvements following tezepelumab treatment in nasal congestion (mean difference [MD] 1.6859, 95% confidence interval [CI] [1.3882; 1.9836]), olfactory function (standardized mean difference [SMD] − 1.17, 95% CI − 1.39 to − 0.95), SNOT-22 scores (MD 28.6091, 95% CI [15.9241; 41.2940]), and asthma control (ACQ SMD 1.06, 95% CI 0.54–1.57). Both the asthma with nasal polyps and CRSwNP subgroups exhibited consistent symptom improvement. Changes in FEV₁ were modest and did not reach statistical significance. Conclusion: Tezepelumab was associated with significant improvements in rhinologic and asthma-related outcomes in patients with CRSwNP. Larger, well-designed randomized controlled trials are warranted to confirm these findings and to define more accurately the long-term therapeutic role of tezepelumab in this population.