Efficacy and safety of monoclonal antibody therapy for chronic rhinosinusitis with nasal polyposis

Abstract

Chronic rhinosinusitis (CRS) is one of the most common chronic inflammatory syndromes reported in the general population, with high prevalence reported. It is classified in two distinct entities depending on the endotype dominance, either type 2 or non-type 2, – chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps. CRSwNP is described as a type 2 inflammatory disease, with the implication of T-helper 2 inflammation mechanisms with a secondary increase in the concentration of eosinophils and total Immunoglobulin E. CRSwNP is characterized by a high recurrence rate even after endoscopic sinus surgery. Considering the challenges associated with the treatment of CRSwNP, new medical therapies, such as monoclonal antibodies, have been developed over the years. Biologics with anti-IL-5, anti-IgE, anti-IL-4 receptor alpha (IL-4-Rα) action have been developed and tested for the treatment of asthma, eosinophilic dermatitis, and secondarily evaluated and approved for the treatment of chronic rhinosinusitis with nasal polyps. In this review, we make a synthesis of the monoclonal antibodies available and their efficacy and safety in the treatment of nasal polyposis.