Efficacy of Biologics in Aspirin Exacerbated Respiratory Disease: A Narrative Review

Background: Aspirin-exacerbated respiratory disease (AERD), also termed nonsteroidal anti-inflammatory drug exacerbated respiratory disease (NERD), is characterized by eosinophilic asthma, chronic rhinosinusitis with nasal polyposis, and hypersensitivity to cyclooxygenase-1 inhibitors, frequently resulting in severe, treatment-refractory airway disease. Biologic therapies targeting type 2 inflammation are increasingly used in AERD; though their relative efficacy remains incompletely defined. Methods : We conducted a semi-systematic narrative review of biologic therapies in AERD, guided by established narrative review frameworks. PubMed/Medline, ScienceDirect, and ClinicalTrials.gov were searched for studies reporting clinical outcomes in AERD/NERD or clearly defined AERD/NERD subgroups. Results: Eighteen studies identified, including randomized trials, observational studies, and case series. Across these studies, dupilumab was most consistently associated with improvements in both upper and lower airway outcomes. Anti–IL-5 and anti–IL-5Rα therapies reduced eosinophilia and asthma exacerbations, with variable sinonasal benefit. Omalizumab demonstrated efficacy in selected atopic phenotypes and in conjunction with aspirin therapy following desensitization. Emerging subgroup data suggest that tezepelumab may reduce asthma exacerbations in AERD. Conclusions: Current evidence suggests biologic therapies provide meaningful benefit in AERD, although available evidence is limited by small sample sizes and heterogeneous designs. Prospective comparative studies are needed to inform optimal biologic selection and sequencing.