Table 3_Predictive biomarkers of biologic therapy response in chronic rhinosinusitis with nasal polyps: a systematic review.docx

Certainty of evidence was assessed using GRADE.</p>Results<p>Meta-analysis demonstrated that elevated eosinophils (>300 cells/µL or study-defined high) increased odds of SNOT-22 improvement (OR 3.07, 95% CI 2.00–4.72, p < 0.00001, I² = 0%) and ≥1-point NPS reduction (OR 2.83, 95% CI 1.86–4.30, p < 0.00001, I² = 0%). Serum IgE and other biomarkers (ECP, cytokine panels, radiologic markers) showed inconsistent associations with response across studies.

Certainty of evidence was low to very low due to observational designs, heterogeneity, and imprecision. Funnel plot symmetry and Egger's test (p = 0.36) suggested minimal publication bias.</p>Conclusion<p>Current evidence, though limited by low certainty, suggests baseline peripheral eosinophil count is the most consistent predictor of biologic response in CRSwNP. These findings support further investigation of eosinophils as a potential predictive biomarker, but prospective validation is needed before clinical implementation.

Other biomarkers showed inconsistent predictive value across studies.</p>Systematic Review Registration<p>PROSPERO CRD420251251904.</p>