Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) can be a severe and debilitating disease associated with significant morbidity, complete anosmia, sinus pressure, and asthma exacerbations. Eosinophils play a role in the majority (85%) of patients. Benralizumab, an afucosylated monoclonal antibody directed against the IL-5 receptor has powerful apoptotic effects on eosinophils. Objective: We sought to investigate the therapeutic benefit of inhibiting the IL-5 receptor using benralizumab to treat severe nasal polyposis. Methods: Twenty-four patients (n = 24) with severe NP (grade 5 or more out of 8) with elevated eosinophils and a history of previous polypectomy were randomized in a double-blind fashion to receive 30mg benralizumab SC or placebo. Endoscopic NP score was assessed at baseline and at treatment week 20. CT scan, SNOT-22 survey, and UPSIT smell test score changes were also evaluated from baseline. Results: Compared to baseline, 8 out 12 patients receiving benralizumab had a significantly improved NP score versus 4 out of 12 placebo. 5 of 12 benralizumab treated patients had improvements in all major outcomes (polyp score, CT, SNOT-22 and smell test) versus 2 out of 12 placebo. The ratio of blood eosinophil count to allergen skin test positivity correlated with polyp reduction. Conclusion: Compared to baseline, benralizumab achieved a statistically significant reduction in polyp size by endoscopy and CT scan and was associated with both less symptoms and improved sensation of smell for most patients (10 of 12).