European Academy of Allergy and Clinical Immunology position paper on endoscopic scoring of nasal polyposis

Gevaert, Philippe; Craemer, Jarno De; Bachert, Claus; Blauwblomme, Manon; Chaker, Adam; Cingi, Cemal; Hellings, Peter; Hopkins, Claire; Hox, Valérie; Fokkens, Wytske J.; Klimek, Ludger; Lund, Valerie J.; Mösges, Ralph; Mullol, Joaquim; Pfaar, Oliver; Scadding, Glenis; Tomazic, Peter Valentin; Zele, Thibaut Van; Vlaminck, Stephan; Wagenmann, Martin; Toppila‐Salmi, Sanna; Alobid, Isam

doi:10.1111/all.15650

Cited by 23 publications

(16 citation statements)

References 37 publications

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“…As an example of the latter, a prevailing single low‐volume polyp medial of the middle turbinate with otherwise healthy sinonasal mucosa would often result in an unfavorable score (unilateral NPS 3 out of 4), unrepresentative for the situation. The recent EEACI position paper on a unified endoscopic NP scoring system hurdles this issue and similar others and represents a significant step toward a representative reference standard in the biologicals era 85 . In our study, upper outliers with a total NPS >4 from 24‐weeks onward were principally based on low‐volume polyps with an unfavorable location, which would more representatively score 1–2 points lower had this new scoring system been applied.…”

Section: Discussionmentioning

confidence: 67%

Two‐year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months

Lans

Otten

Adriaensen

et al. 2023

Allergy

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BackgroundDupilumab is an anti‐T2‐inflammatory biological registered for chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), indicated by integrated CRS‐care pathways when optimal medico‐surgical treatment yields insufficient CRS control. This study aims to evaluate long‐term results with focus on established therapeutic efficacy while tapering dupilumab.MethodsReal‐life, prospective observational cohort study in single tertiary referral center with add‐on dupilumab as primary biological treatment in adult (≥18 years) biological‐naïve CRSwNP patients per the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS)2020‐indication with a 2‐year follow‐up. Tapering (increasing interdose interval) applied every 24 weeks, conditional to sufficient treatment response and CRS control.ResultsMean scores (s.d.) of all co‐primary outcomes improved significantly from baseline ( 228) to the 48 ( 214) and 96‐weeks ( 99) timepoints: Nasal Polyp Score (0–8) improved from 5,3 (1,9) to 1,4 (1,8) and 1,3 (1,7); SinoNasal Outcome Test (SNOT)‐22 (0–110) improved from 53,6 (19,6) to 20,2 (15,4) and 21,2 (15,6); Sniffin’Sticks‐12 identification test (0–12; 0–6 anosmia, 7–10 hyposmia, 11–12 normosmia) improved from 3,7 (2,4) to 7,7 (2,9) and 7,3 (3,04); Asthma Control Test (5–25; >19 indicating well‐controlled asthma) improved from 18,5 (4,8) to 21,8 (3,8) and 21,4 (3,9). Tapering was feasible in 79,5% of the patients at the 24‐weeks timepoint, and in 93,7% and 95,8% at the 48‐ and 96‐weeks timepoints, respectively. One‐way repeated‐measures ANOVA demonstrated no significant alterations of individual co‐primary outcome mean‐scores from 24 weeks onward.ConclusionThis first long‐term real‐life prospective observational cohort study shows high therapeutic efficacy of dupilumab for severe CRswNP in the first 2 years. Therapeutic efficacy is principally established within 24 weeks and endures while tapering dupilumab conditional to treatment response and CRS control.

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Section: Discussionmentioning

confidence: 67%

Two‐year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months

Lans

Otten

Adriaensen

et al. 2023

Allergy

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“…Diffuse nasal polyps constitute a form of chronic rhinosinusitis and consist of inflammatory lesions that project into the nasal airway, are typically bilateral,2 more common in men2 3 and their prevalence increases with age 3. The nasal polyp score is a grading system used to describe polyps, which ranges from 0 to 4, with 4 corresponding to the maximum degree and can be described as complete obstruction of the nasal cavities,4 however it generally does not go beyond the nasopharynx.…”

Section: Descriptionmentioning

confidence: 99%

Nasal polyps causing airway obstruction

Barreto,

Cunha-Cabral,

Duarte

et al. 2024

BMJ Case Rep

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“…Although the various nasal polyp scoring systems have been comprehensively reviewed and compared previously (191) , it is worth noting that all nasal polyp scoring systems have certain limitations. Most prominently, the nonlinear and ordinal nature of these systems creates an inherent lack of detection of minor changes in nasal polyp size (191,192) . This is most clearly noticeable in the LKS where polyps beyond the middle meatus (e.g.…”

Section: Nasal Polyp Score (Nps)mentioning

confidence: 99%

Outcome measures for chronic rhinosinusitis with nasal polyps

Sedaghat,

Campbell,

Douglas

et al. 2024

Rhin

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Background: With the recent proliferation of novel therapeutics for chronic rhinosinusitis with nasal polyps (CRSwNP), there is an immediate need for comprehensive means to assess CRSwNP disease status as well as to determine treatment efficacy. Outcome measures exist in different forms. Patient-reported outcome measures (PROMs) allow patients to provide direct input about their condition that is not possible to obtain in any other way. Common constructs that are measured using PROMs include quality of life or the burden of disease manifestations (e.g., symptom severity). Outcomes may also include the results of objective diagnostic testing/measurement of clinical signs or measured using psychophysical tests. Biomarkers represent an emerging class of outcome measures for CRSwNP and are chosen to directly reflect the active pathophysiologic processes of CRSwNP in the peripheral blood, sinus/polyp tissues, and sinonasal mucus. Methods: Narrative review of the literature, identifying and describing outcome measures that may be used in the evaluation of CRSwNP and for assessment of treatment responses. Results: In this review, we identify many different outcome measures for CRSwNP that fall under the categories of PROM, objective test, psychophysical test or biomarker. We describe the history of each - including seminal studies - and demonstrate the formal validation, psychometric performance, and limitations of each. Conclusions: PROMs, objective tests, psychophysical tests and biomarkers represent different classes of outcome measures that are complementary means of assessing CRSwNP disease status and treatment efficacy. The choice or interpretation of a CRSwNP outcome measure should be undertaken with full knowledge of its formal validation, psychometric performance, and limitations.

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European Academy of Allergy and Clinical Immunology position paper on endoscopic scoring of nasal polyposis

Abstract: Nasal endoscopy is not only used for the diagnosis of chronic rhinosinusitis with nasal polyps (CRSwNP), but also for monitoring the response to therapy playing an important role in both daily practice and research.

Cited by 23 publications

References 37 publications

Two‐year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months

Two‐year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months

Nasal polyps causing airway obstruction

Outcome measures for chronic rhinosinusitis with nasal polyps

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