Background: Biological therapy is a newer line of treatment that has been utilized in the practice for patients with chronic rhinosinusitis with nasal polyps with excellent results. Similarly, recent advancements in the understanding of the pathophysiology of allergic fungal rhinosinusitis (AFRS) have prompted the investigation of biologics as a possible treatment option. Hence, our aim is to highlight the significance of biologics in the management of AFRS. Methods: Using the Web of Science, Cochrane, MEDLINE, and Embase databases, we analyzed studies that used biologics in AFRS patients which were published until February 2024. The studies were extracted, and data were pooled for meta-analysis. Results: Of 1103 studies identified, eight studies were included in the systematic review, in which five of them were involved in the meta-analysis. Results showed significant effects of biologics in terms of SNOT-22 score, demonstrating a mean improvement of 62%, with the Dupilumab group exhibiting the highest improvement rate. Our pooled analysis showed that biologics have significantly decreased the SNOT-22 and Philpott-Javer staging score (35.5; p<0.0001) and (33.53; p=0.005), respectively. Also, our findings showed that biologics have significantly decreased the level of total IgE and serum eosinophil. Lastly, the overall recurrence rate and adverse events rate were found to be 3.3% and 1.7%, respectively. Conclusion: This review recognized favourable effects and safety of biological therapy in the management of AFRS. Biologics demonstrated a marked improvement in clinical findings, laboratory markers, and perhaps eliminating the burden of surgical revisions and recurrence rates, with the safety profile appearing favourable.

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