Clinical remission in chronic rhinosinusitis with nasal polyps: a Delphi consensus from the Rhinosinusitis Italian Network (RINET)

Background: The concept of clinical remission in CRSwNP is gaining growing relevance in the era of biologic therapies. However, current definitions remain heterogeneous and lack standardized, operational criteria. This variability limits comparability across studies and hinders the implementation of remission as a therapeutic target in routine practice. Objective: To develop a multidisciplinary, evidence-based, and clinically applicable definition of clinical remission in CRSwNP, integrating symptom-based, endoscopic, therapeutic, and timing-related criteria, and to evaluate expert consensus on the development of a composite remission score. Methods: A three-round Delphi consensus was conducted among experts participating in the Rhinosinusitis Italian Network (RINET). Across the three rounds, experts rated the statements using a 5-point Likert scale. Positive or negative consensus was defined as ≥70% agreement or disagreement, respectively. Descriptive statistics assessed the convergence and stability of responses. Results: Experts agreed that remission requires meeting concurrent criteria across four domains: timing (≥12 months), absence of systemic corticosteroid use or surgical indication, symptom thresholds (SNOT-22 <20 plus symptoms and hyposmia VAS ≤ 3), and endoscopic thresholds (Nasal Polyp Score and modified Lund-Kennedy score both 0 for complete remission; both ≤2 for partial remission). Consensus emerged on differentiating complete and partial remission, on introducing the concept of sustained remission (≥24 months), and on the need for a composite remission score with weighted components and category thresholds. Conclusion: This Delphi consensus provides the first operational, multidomain definition of complete and partial clinical remission in CRSwNP, developed independently by a large multidisciplinary panel and informed by patient perspectives. The proposed criteria offer a practical framework to standardize remission assessment and support its adoption as a therapeutic goal.