Chronic Rhinosinusitis Optimisation of Nasal Outcomes and Scores (CHRONOS): An Italian Delphi Consensus on Long-Term Management with Biologics

Purpose of review: This review synthesizes current evidence and expert consensus on the long-term management of severe chronic rhinosinusitis with nasal polyps (CRSwNP) treated with biologics, as established by the Italian CHRONOS project. Recent findings: Accumulating real-world and clinical trial data confirm the sustained efficacy and safety of biologics targeting type 2 inflammation, enabling durable control and remission in a significant proportion of patients. Personalized dosing regimens, including dose-spacing strategies, appear feasible. The CHRONOS project provides practical guidance for optimizing long-term biologic therapy in severe CRSwNP. Response assessment should combine subjective and objective measures, especially for olfactory testing. Biologics may be considered before surgery only in selected complex cases. Dose-spacing strategies may be appropriate in stable patients but require multidisciplinary oversight in those with comorbid asthma. Adverse events are uncommon. The concept of disease modification is endorsed, recognizing biologics' potential to alter the natural history of CRSwNP. Keywords: Biological therapy; Chronic rhinosinusitis with nasal polyps; Disease modification; Dupilumab; Long-term management; Mepolizumab; Omalizumab; Remission; Type 2 inflammation.