Short-Term Efficacy of Biologics in Recalcitrant Allergic Fungal Rhinosinusitis: A Systematic Review and Meta-analysis

Objective: Allergic fungal rhinosinusitis (AFRS) is characterized by type I immunoglobulin E (IgE)-mediated hypersensitivity reactions to fungal antigens. This systematic review and meta-analysis assessed the efficacy of biologics in the management of refractory AFRS. Data Sources: PubMed, SCOPUS, Embase, Web of Science, and Cochrane. Review Methods: Changes in Sino-Nasal Outcome Test (SNOT)-22 scores, endoscopic findings, serum eosinophil count, and total IgE levels were assessed in patients with refractory AFRS after receiving biologic therapy. Subgroup analyses were conducted to evaluate the individual efficacy of each biologic agent, including dupilumab, mepolizumab, and omalizumab. Results: A total of 60 patients from 6 studies were analyzed. Biologics showed a significant improvement in SNOT-22 scores (standard mean difference 1.1607 [95% CI 0.5549; 1.7664]), endoscopic scores (2.1953 [1.4181; 2.9725]), serum eosinophil count (1.1649 [0.7735; 1.5563]), and total IgE level (1.0700 [0.4052; 1.7348]). Dupilumab, mepolizumab, and omalizumab all enhanced SNOT-22 and endoscopic scores. Additionally, dupilumab significantly reduced total IgE levels (1.2981 [0.4063; 2.1900]), whereas both dupilumab (0.9274 [0.1592; 1.6957]) and mepolizumab (1.2324 [0.9215; 1.5433]) significantly lowered the serum eosinophil counts. Conclusion: The agents significantly improved nasal symptoms, laboratory findings, and endoscopic scores. These findings support the potential role of biologics as a therapeutic option for patients with AFRS who are unresponsive to conventional treatments.