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Biologics for Nasal Polyps: Injections, Surgery, or Both

| Latif M. Dharamsi, MD | Sinus & Nasal | Reviewed Sep 2026
Home Ask the ENT Biologics for Nasal Polyps: Injections, Surgery, or Both

Quick answer: Biologics are injectable medicines that calm the specific type of inflammation that grows nasal polyps. Four are FDA-approved, and we prescribe and manage all of them in our office. Dupixent (dupilumab) is the one used most often. In clinical trials they shrink polyps, open the sinuses on a CT scan, ease congestion, and lower the odds of needing another polyp operation. They are not a cure: polyps usually return if you stop, so this is ongoing treatment. Biologics are not a first step either. Steroid nasal sprays come first, and surgery is still the usual next move when sprays are not enough. Many people end up doing both.

Nasal polyps are soft, noncancerous swellings that grow in the lining of the nose and sinuses. When they get large enough, they block airflow, dull or erase the sense of smell, and cause constant congestion and pressure. The frustrating part for most patients is not getting rid of them once. It is that they keep coming back.

Biologics changed that conversation. They are the first medicines that treat the inflammation driving polyp growth rather than only the symptoms.

What Are Biologics?

Biologics are medicines made from living cells and designed to block one specific signal in the immune system. Nasal polyps are usually driven by what doctors call type 2 inflammation, the same process behind asthma and eczema. That is why so many people with polyps also have asthma.

Four biologics are FDA-approved for chronic rhinosinusitis with nasal polyps:

  • Dupixent (dupilumab), an injection every two weeks, and the one used most often for polyps
  • Xolair (omalizumab), dosed by body weight and blood test results
  • Nucala (mepolizumab), an injection every four weeks
  • Tezspire (tezepelumab), an injection every four weeks, approved for nasal polyps in October 2025 and the newest of the four

All four are given as a shot under the skin, and many patients give it to themselves at home after being taught how. We prescribe and manage all four here in our office, including the insurance approval, so you are not sent elsewhere to start treatment.

How Well Do Biologics Work?

The evidence is strong. Two randomized trials in The Lancet tested dupilumab in adults with severe nasal polyps. Compared with a placebo, it shrank the polyps, cleared the sinuses on CT scans, and eased congestion. Side effects were no more common than with the placebo.

These medicines also cut the need for rescue treatment. An analysis in the Journal of Allergy and Clinical Immunology pooled 29 randomized trials. Dupilumab lowered the chance of needing another polyp operation by about 16 percentage points. Omalizumab and mepolizumab helped less. Dupilumab ranked among the most effective on every outcome the analysis measured.

Tezspire is the newest option, and its results were striking. In a 52-week trial in The New England Journal of Medicine, polyp surgery became necessary for 0.5% of patients on tezepelumab compared with 22.1% on placebo. Polyp size, congestion, and sense of smell all improved as well. Because this approval came in late 2025, the guidelines below were written before it.

In 2023 the national allergy and immunology task force reviewed the evidence for the older biologics and suggested them for people with nasal polyps. The wording is deliberate. These medicines help most people who take them, though not everyone, so the choice depends on how much your polyps affect you.

Improvement is gradual. Congestion often eases within the first weeks, while the sense of smell takes longer and may return only partly. We recheck with nasal endoscopy, a quick camera look in the office, to see how the polyps are responding.

Who Is a Good Candidate?

Biologics are for people whose polyps are not controlled by the standard first steps, which are daily steroid nasal sprays and saline rinses. Every major trial required patients to have tried a steroid spray first, and about half of the people enrolled had already had polyp surgery. You may be a candidate if:

  • Your polyps came back after polyp surgery
  • Sprays and rinses are not keeping your nose open
  • You are relying on repeated courses of oral steroids, which carry real risks over time
  • You also have asthma, which a biologic may treat at the same time
  • You have aspirin-exacerbated respiratory disease, the combination of polyps, asthma, and reactions to aspirin and similar pain relievers
  • Surgery is not a good option for you because of other health conditions

Biologics or Surgery?

This is the question most patients have, and it deserves a straight answer: no randomized trial has ever compared surgery against a biologic head-to-head. The 2025 national sinusitis guideline treats them as steps in order, not as a either-or choice. A steroid spray comes first. When sprays are not enough, surgery is still the usual next step.

What we do know about each:

  • Surgery removes polyps and opens the sinuses in one procedure, so relief comes quickly.
  • Surgery also lets steroid rinses reach the sinus lining afterward.
  • A biologic avoids an operation and treats the inflammation itself, including asthma if you have it.
  • A biologic works gradually and needs insurance approval.
  • It means an injection every two to four weeks for the long term, and it stops working if you stop.

Polyps do return after surgery for some people. The 2025 guideline on sinus surgery reports regrowth in roughly 40% of patients by about 18 months, and around 20% have a second operation within five years.

Comparisons outside of trials suggest surgery shrinks polyps faster at first. Dupilumab tends to do better for smell. By about a year, scope and scan findings look similar either way. Our page on endoscopic sinus surgery explains what surgery involves, and our post on when you need sinus surgery covers how that decision gets made.

In practice these are not competing choices. Many patients have surgery to clear extensive polyps and then use a biologic to hold the result. Others start a biologic first, particularly when surgery is risky for them or their asthma is also poorly controlled.

What About Cost and Insurance?

Biologics are expensive, and insurance plans nearly always require prior authorization. Plans usually want records of your polyps and the treatments you have already tried, and often proof of previous surgery. Cost and approval requirements are a large part of why surgery still comes earlier in most treatment plans. Our staff handles the paperwork, and manufacturer copay assistance programs can lower out-of-pocket costs for patients with commercial insurance. We go over what your plan covers before you start.

What Are the Side Effects?

In the nasal polyp trials, side effects were no more frequent with the biologic than with placebo. The most common issues are redness or soreness where the injection goes in, headache, and joint aches. Dupilumab can cause eye irritation or dryness in some patients, which is usually treatable. Because these medicines quiet part of the immune system, your physician will review your health history before starting one.

See an ENT Specialist

Come see us if your nose is still blocked, your sense of smell has not come back, or the polyps have returned after surgery. Our physicians will look in your nose with an endoscope and review your CT scan and the treatments you have tried. Then we lay out the options: medication, surgery, a biologic, or a combination. If a biologic is the right fit, we prescribe it and follow you here.

Sources

This article is for educational purposes only and does not replace an in-person evaluation.

Medically reviewed by Dr. Latif Dharamsi · Last updated September 28, 2026

Latif M. Dharamsi, MD

Dr. Dharamsi is a board-certified otolaryngologist at Capital ENT & Sinus Center, serving patients in Austin and Lakeway. He completed his medical training at Vanderbilt University and treats a wide range of ENT conditions in patients of all ages. A 2024 and 2025 Austin Monthly Top Doctor, he emphasizes minimally invasive treatments and a team-based approach to care.

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