Biologics for Chronic Rhinosinusitis—A Modern Option for Therapy

Abstract

Chronic rhinosinusitis (CRS) is an important ENT pathology which affects about 5–12% of the general population. The treatment of CRS can be pharmacological (nasal sprays, douches, systemic antibiotics and steroids), surgical (endoscopic sinus surgery) or immunological according to established algorithms. CRS was divided for many years into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). New ways of classifying CRS by endotypes (presence of neutrophilia, eosinophilia, fibrosis, glandular hypertrophy and epithelial dysmorphisms) appeared after the most recent understandings of the pathophysiology of the disease. Other classifications divide CRS into primary and secondary forms, localized/diffuse types and anatomical presentation. A new type of treatment has been administered in the last years, biologics. For the moment, biologics are indicated just in the cases of the patients who have undergone ESS or have contraindications for surgery and have bilateral polyps and meet a minimum of three of the following criteria: the necessity for systemic therapies with oral or parenteral corticosteroids or contraindications to systemic steroids, significant loss of smell or impaired QoL score, comorbid asthma and type 2 inflammation. This article aims to present the most relevant studies which used the three types of biologics (anti-IgE, anti-IL5 and anti-IL4/IL3) and wishes to increase the awareness of this new type of treatment that can be used in some CRS cases.

Redefining the Role of Nutrition in Infant Food Allergy Prevention: A Narrative Review

“…Some birth or early childhood cohort studies suggest that the atopic march only occurs in approximately 50% of children with AD [ 30 , 31 , 32 , 33 , 34 ]. Recently, several biologics targeting the TH2 pathway, including dupiliumab and omalizumab, have been approved to treat conditions associated with the atopic march, and it has been hypothesized that these drugs may help to interrupt the atopic march [ 35 , 36 ].…”

A Comprehensive Review Exploring Allergic Rhinitis With Nasal Polyps: Mechanisms, Management, and Emerging Therapies

“…Biologic agents offer a contemporary therapeutic avenue for CRSwNP, with the FDA's approval of mepolizumab marking a significant milestone as the first biologic agent sanctioned for this condition [ 52 ]. Alongside mepolizumab, dupilumab and omalizumab are the two other FDA-approved biologics targeting type 2 inflammation in NP [ 53 ].…”

“…Alongside mepolizumab, dupilumab and omalizumab are the two other FDA-approved biologics targeting type 2 inflammation in NP [ 53 ]. Indicated for patients with bilateral NP, these biologics have demonstrated notable improvements in symptoms and quality of life [ 52 ]. The utilization of biologics in CRSwNP represents a swiftly progressing field, with ongoing research aimed at pinpointing the most suitable candidates for these therapies and refining the timing of treatment initiation.…”

“…The utilization of biologics in CRSwNP represents a swiftly progressing field, with ongoing research aimed at pinpointing the most suitable candidates for these therapies and refining the timing of treatment initiation. A proposed study design outlines gathering data regarding the timing of biologic therapy initiation, focusing on patients with CRSwNP who have undergone previous surgical intervention [ 52 ]. The study aims to compare the effects of initiating biologic therapy at various time points post-surgery.…”

The Effectiveness of Biological Agents on Chronic Rhinosinusitis with Nasal Polyposis in Patients with Comorbid Asthma: A Multicenter Real-Life Study from Türkiye

“…The U.S. Food and Drug Administration approved dupilumab, anti-IL-4/IL-13; 2019, omalizumab, anti-IgE; 2020, and mepolizumab, anti-IL-5; 2021 to treat adults with CRSwNP [ 20 ]. Since there is no access to BAs within the scope of public health insurance for CRSwNP in Türkiye, many patients are deprived of these agents.…”