Can We Safely Taper? A New Question in CRSwNP Management

Commentary by Macaulay Ojeaga, MD on the article:

Liang J, Lin SY. Tapering Biologic Therapy in Chronic Rhinosinusitis With Nasal Polyps. JAMA Otolaryngol Head Neck Surg. 2026 Feb 1;152(2):115-116. doi: 10.1001/jamaoto.2025.4675. PMID: 41452610.

Biologic therapy has transformed the management of chronic rhinosinusitis with nasal polyposis. Prior to the introduction of biologics, patients with CRSwNP often required repeated courses of antibiotics, intranasal and systemic corticosteroids, and multiple surgical procedures. Today, biologics such as dupilumab provide sustained symptom relief, improved olfaction, and meaningful gains in quality of life. Yet as clinicians we are increasingly asking: how long should therapy continue?

As highlighted in the viewpoint by Jonathan Liang and Sandra Y. Lin, current treatment paradigms are largely based on fixed-interval dosing without clear guidance on de-escalation. While clinical trials demonstrate the efficacy and safety of biologics, they do not address duration of treatment. Clinical experience shows that some patients can maintain disease control with less frequent dosing, challenging the need for a uniform approach.

The authors propose a pragmatic tapering strategy, beginning with patients who demonstrate a strong response at six months. Gradual extension of dosing intervals, along with close monitoring and a low threshold to return to standard therapy, offers a balanced approach to maintaining control while minimizing treatment burden.

Tapering biologics is more than convenience. Reducing cumulative exposure may limit unknown long-term immunologic effects, lower costs, and improve patient acceptance of therapy. At the same time, careful patient selection and objective monitoring remain essential to avoid disease recurrence.

Biologics have reshaped CRSwNP care. The next step is defining how and in whom they can be safely scaled back.