ARIA-ITALY multidisciplinary consensus on nasal polyposis and biological treatments

Lombardi, Carlo; Asero, Riccardo; Bagnasco, Diego; Blasi, Francesco; Bonini, Matteo; Bussi, Mario; Canevari, Frank Rikki; Canonica, Giorgio Walter; Castelnuovo, Paolo; Cecchi, Lorenzo; Cosmi, Lorenzo; Gelardi, Matteo; Heffler, Enrico; Indinnimeo, Luciana; Landi, Massimo; Licari, Amelia; Liotta, Francesco; Macchi, Alberto; Malvezzi, Luca; Micheletto, Claudio; Musarra, Antonino; Peroni, Diego; Piacentini, Giorgio; Poletti, Venerino; Richeldi, Luca; Santoni, Angela; Schiappoli, Michele; Senna, Gianenrico; Vaghi, Adriano; Villani, Alberto; Passalacqua, Giovanni; Italia, Aria

doi:10.1016/j.waojou.2021.100592

Cited by 18 publications

(17 citation statements)

References 39 publications

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“…A score > 50 usually indicates uncontrolled disease or patient’s quality of life severely impaired by NP. This questionnaire should be self-completed by the patient [ 14 ]. Several studies reported a significant QoL outcome improvement after ESS by using SNOT-22.…”

Section: Results and Discussion Of Patients’ Management Flowsmentioning

confidence: 99%

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Management of Patients with Severe Asthma and Chronic Rhinosinusitis with Nasal Polyps: A Multidisciplinary Shared Approach

Seccia

D’Amato

Scioscia

et al. 2022

JPM

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Chronic rhinosinusitis (CRS) is one of the most frequent comorbidities associated with asthma and it contributes to an amplified global disease burden in asthmatics. CRS prevalence is much higher in asthmatic patients compared to the general population and it is more frequently related to severe asthma, especially in presence of nasal polyps (chronic rhinosinusitis with nasal polyps, CRSwNP). Moreover, asthma exacerbation has a higher occurrence in CRSwNP. From a pathologic point of view, CRS and asthma share similar and connected mechanisms (e.g., type-2 inflammation). A multidisciplinary approach represents a crucial aspect for the optimal management of patients with concomitant asthma and CRSwNP and improvement of patient quality of life. An Italian panel of clinicians with different clinical expertise (pulmonologists, ear, nose and throat specialists, immunologists and allergy physicians) identified three different profiles of patients with coexisting asthma and nasal symptoms and discussed the specific tracks to guide a comprehensive approach to their diagnostic and therapeutic management. Currently available biological agents for the treatment of severe asthma act either on eosinophil-centered signaling network or type-2 inflammation, resulting to be effective also in CRSwNP and representing a valid option for patients with concomitant conditions.

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Section: Results and Discussion Of Patients’ Management Flowsmentioning

confidence: 99%

“…Consequently, their knowledge of the pathogenic mechanisms and the new treatment options is essential to promote a common approach, in particular when considering monoclonal antibodies (mAb) therapy in case of difficult to treat CRSwNP [ 8 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Management of Patients with Severe Asthma and Chronic Rhinosinusitis with Nasal Polyps: A Multidisciplinary Shared Approach

Seccia

D’Amato

Scioscia

et al. 2022

JPM

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“…Greater understanding of the molecular mechanisms of type 2 inflammation has led to the development of targeted biological drugs, in order to overcome these limitations [ 7 , 8 , 9 ]. Given the large variety of treatment options and guidance, management of CRSwNP is highly variable in routine clinical practice and often depends on the subjective clinical judgement of the clinician, as highlighted by previous studies [ 5 , 10 , 11 , 12 , 13 , 14 ]. In order to shed light on clinical practice in Italy, we carried out a nationwide survey to capture current trends regarding the use of topical and systemic steroids in patients with CRSwNP trying to highlight clinical unmet needs in this field.…”

Section: Introductionmentioning

confidence: 99%

Survey on Use of Local and Systemic Corticosteroids in the Management of Chronic Rhinosinusitis with Nasal Polyps: Identification of Unmet Clinical Needs

Corso

Pipolo²,

Cantone

et al. 2022

JPM

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Background: Local and systemic corticosteroids have long been the workhorse in management of chronic rhinosinusitis with nasal polyps (CRSwNP), although there is no universally accepted modality of prescription. We carried out a survey in Italy to capture current trends in the use of topical and systemic corticosteroids in patients with CRSwNP. Methods: A survey was set up on Survey Monkey®. Each author distributed the link to the survey in an ad hoc manner and a total of 437 participants filled out the survey. Results: Mometasone furoate (79.3%) was the most frequently prescribed, administered daily by 61.9% of participants; the remaining preferred to discontinue treatment for brief periods to reduce side effects or to modulate the therapy in mild cases. The majority believe that a short cycle of systemic steroids should be prescribed for re-exacerbation of symptoms and that the number of cycles in the previous year should be evaluated to define control of the disease even if international guidelines do not provide clear indications on this topic. A certain degree of divergence emerged from responses regarding how long and the maximal dose of systemic steroids which place patients at high risk for adverse events. Finally, systemic corticosteroids seem to offer only temporary benefit on recovery of smell without guaranteeing long-term control even if the patient is adherent to topical corticosteroids. Conclusions: Our results highlight the need for clear guidelines on oral steroids, which could help supporting the use of a precision medicine approach, including indications for new biological agents.

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“…Despite being relatively easy to diagnose, CRSwNP is characterized by several unmet needs, such as poor knowledge of etiology and the association with some asthma phenotypes [ 6 ]. In addition, CRSwNP was found to adversely affect many aspects of a person’s quality of life (QoL), assessed through both the Study Short Form-6D (SF-6D) and the Euroqol 5-Dimension (EQ-5D) questionnaires, involving general-health survey inquiries measuring physical functioning, role limitations, social functioning, bodily pain, mental health, and vitality [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Cost–Utility Analysis of Dupilumab for the Treatment of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in Italy

Corso

Furneri²,

Salsi

et al. 2022

JPM

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The objective of this analysis was to estimate the incremental cost–utility ratio (ICUR) of dupilumab as an add-on treatment to best supportive care (BSC), versus BSC alone, in Italy for severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). A simulation of outcomes and costs was undertaken using a 1-year decision tree, followed by a lifetime horizon Markov model. Clinical data were derived from a pooled analysis of two studies (SINUS-24 NCT02912468 and SINUS-52 NCT02898454). The Italian National Healthcare Service (NHS) perspective was considered. Model robustness was tested through sensitivity analyses. In the base-case analysis, treatment with dupilumab + BSC resulted in an increase in quality of life-adjusted survival (+1.02 quality-adjusted life years (QALY-gained)), compared to the BSC alone. The resulted ICUR was €21,817 per QALY-gained and it is below the acceptability threshold commonly used in Italy. Both one-way deterministic and probabilistic sensitivity analyses confirmed the robustness of base-case results. The cost–utility analysis showed that dupilumab, as an add-on treatment to BSC, is a cost-effective therapeutic alternative to BSC in the treatment of patients with severe uncontrolled chronic rhinosinusitis with nasal polyps, confirming that it is economically sustainable.

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ARIA-ITALY multidisciplinary consensus on nasal polyposis and biological treatments

Cited by 18 publications

References 39 publications

Management of Patients with Severe Asthma and Chronic Rhinosinusitis with Nasal Polyps: A Multidisciplinary Shared Approach

Management of Patients with Severe Asthma and Chronic Rhinosinusitis with Nasal Polyps: A Multidisciplinary Shared Approach

Survey on Use of Local and Systemic Corticosteroids in the Management of Chronic Rhinosinusitis with Nasal Polyps: Identification of Unmet Clinical Needs

Cost–Utility Analysis of Dupilumab for the Treatment of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in Italy

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