Ask the Surgeon: What’s New in Nasal Polyps?

By Rob Thomas, MD (Richmond ENT)

If you’ve struggled with nasal polyps, you already know how disruptive they can be—blocked breathing, facial pressure, constant drainage, and losing your sense of smell. The good news is that treatment options have expanded quickly in recent years, and there’s an important update:

In October 2025, the FDA approved TEZSPIRE® (tezepelumab-ekko) as an add-on maintenance treatment for adults and children ages 12+ with inadequately controlled chronic rhinosinusitis with nasal polyps (CRSwNP).

First—what exactly is CRSwNP?

CRSwNP is a chronic inflammatory condition where the lining of the nose and sinuses stays inflamed for months and forms soft, non-cancerous growths called polyps. Polyps can physically block airflow and worsen:

• nasal congestion

• postnasal drip

• facial pressure

• recurrent infections

• decreased or lost sense of smell

We typically start with proven basics: saline rinses, nasal steroid sprays, allergy management, and sometimes short courses of oral steroids. When symptoms keep returning—or polyps come back after surgery—we consider “advanced” options like biologic medicines.

What is TEZSPIRE®?

TEZSPIRE is a prescription biologic injection that blocks a signal involved early in inflammation called TSLP (thymic stromal lymphopoietin).

How it’s used (in plain language):
TEZSPIRE is not meant to replace your daily care (like nasal sprays). It’s used with other medicines to help get better long-term control when CRSwNP is still not well controlled.

Who might be a candidate?

The FDA indication is for patients age 12 and older with inadequately controlled CRSwNP.

In real-world terms, we often consider a biologic like TEZSPIRE when someone has persistent symptoms despite appropriate medical therapy—especially if they:

• have major congestion and smell loss that doesn’t improve

• keep needing oral steroid “bursts”

• have had sinus surgery but polyps returned

• also have asthma or aspirin sensitivity (AERD)

In the pivotal study, many participants had a history similar to the patients we see in clinic: about 71% had prior sinus surgery and 58% had used systemic steroids for CRSwNP in the prior year.

What benefits were seen in the WAYPOINT clinical trial?

The FDA approval was based on a major one-year clinical trial called WAYPOINT, which compared TEZSPIRE to placebo in adults with severe, uncontrolled CRSwNP.

Here’s what that means for patients:

1) Smaller polyps and less congestion

By 52 weeks, patients receiving TEZSPIRE had significantly greater improvement in:

• nasal polyp size (measured by endoscopy score), and

• nasal congestion (patient-reported symptom score)

2) Less need for oral steroids and surgery

This is one of the most meaningful outcomes for many patients. In WAYPOINT, TEZSPIRE:

• reduced the combined need for sinus surgery and/or systemic steroids by 92% vs placebo over 52 weeks

• reduced the need for sinus surgery by 98% and reduced systemic steroid use for CRSwNP by 88% vs placebo

3) Improved smell and sinus inflammation on CT

Patients also had significant improvement in:

• loss of smell, and

• sinus inflammation seen on CT scoring (Lund-Mackay)

Bottom line: For many patients, TEZSPIRE can mean better day-to-day breathing and smell, plus fewer “big” interventions like repeated steroids or another surgery.

How is TEZSPIRE given?

• Dose: 210 mg under the skin (subcutaneous injection) once every 4 weeks

• Depending on the device and your situation, injections may be given in-office or at home after training (your clinician decides what’s appropriate).

What are the potential risks and side effects?

All medications have potential downsides, and biologics are no exception.

Common side effects seen in the CRSwNP study

The more common side effects (≥3%) included:

• nasopharyngitis (“common cold” symptoms)

• upper respiratory infection

• nosebleeds (epistaxis)

• sore throat (pharyngitis)

• back pain

• influenza

• injection-site reactions

• joint pain (arthralgia)

Important safety warnings

• Allergic reactions can occur, including anaphylaxis (rare but serious). Reactions may occur hours after dosing or even days later.

• Parasitic (helminth) infections: patients with known helminth infections should be treated before starting; TEZSPIRE may need to be stopped if infection occurs and doesn’t respond to treatment.

• Vaccines: live attenuated vaccines should be avoided during treatment.

• If you’re on steroids for any reason, they shouldn’t be stopped abruptly without clinician guidance.

Where does this fit at Richmond ENT?

At Richmond ENT, our goal is straightforward: get you breathing and smelling better with the least medication burden and the fewest procedures possible—while still using the right tool for the right patient.

For some people, the best next step is optimizing topical therapy and allergy control. For others, it’s surgery. And for an increasing number of patients with difficult-to-control nasal polyps, biologics like TEZSPIRE are becoming an important option.

Next steps

If you think you may be a candidate, schedule a visit so we can:

• confirm the diagnosis (endoscopy ± CT)

• review what you’ve already tried

• discuss biologic options (including benefits, risks, and insurance requirements)

• build a plan that fits your goals

This blog is educational and not medical advice. Treatment decisions should be individualized with your clinician.