Expert Opinion on Biological Treatment of Chronic Rhinosinusitis with Nasal Polyps in the Gulf Region

Abstract

Chronic rhinosinusitis (CRS) is defined as the inflammation of nose and paranasal sinuses, affecting the patients' quality of life and productivity. Chronic rhinosinusitis with nasal polyps (CRSwNP) is a principal clinical entity confirmed by the existence of chronic sinonasal inflammation and is characterized by anterior or posterior rhinorrhea, nasal congestion, hyposmia and/or facial pressure or facial pain. Several epidemiologic studies have revealed wide variations in the incidence of CRS among regions globally ranging from 4.6% to 12%. The Gulf countries are also witnessing an unprecedented burden of CRSwNP. According to the current clinical guidelines, glucocorticosteroids and antibiotics are the principal pharmacotherapeutic approaches. Endoscopic sinus surgery is recommended for those who have failed maximal pharmacotherapy. Recently, biologics are considered as an alternative best approach due to the complications associated with medical therapy and surgery. However, precise data on the clinical position of biologic agents in the management of CRSwNP in the Gulf region is not available. The present review article addresses the current diagnostic and management approaches for CRSwNP and also emphasizes the role of emerging biologics in the current treatment strategies for CRSwNP in the Gulf region. Further, a consensus protocol was convened to rationalize the guideline recommendations, strategize the best practices with biologics, and develop clinical practice guidelines for all primary-care specialists in the Gulf region. The consensus-based report will be a useful reference tool for primary-care physicians in primary-healthcare settings, regarding the appropriate time for the initiation of biological treatment in the Gulf region.

Dupilumab: An emerging therapy in allergic fungal rhinosinusitis

“…Expert groups and advisory committees from countries of the Gulf Cooperation Council (GCC) support the use of dupilumab in resistant CRSwNP, providing there is an evidence of type 2 inflammation (eg, total IgE ≥100 or serum eosinophils ≥250), impaired quality of life (SNOT-22 ≥40), and, preferably, concomitant asthma. 24 , 25 The present case series found promising outcomes of the dupilumab use in AFRS, as a subset of CRSwNP, among the Saudi population (as part of the Gulf countries ) who met the aforementioned criteria, with no significant adverse events. Future studies on a larger scale should be conducted evaluating the use of biologics in AFRS.…”

“…Accordingly, high-quality guidelines and position papers have been implemented to tackle the aforementioned dilemma. 5 , 24 , 25…”

Assessment of chronic rhinosinusitis with nasal polyps: Development of the Nasal Polyp Patient Assessment Scoring Sheet tool

“… 24 A study on patient‐reported and practitioner‐reported outcomes for CRS concluded that 3% of responses generated were objective measures, whereas the majority were subjective, thus highlighting that primary outcomes in future reviews should focus on subjective outcomes in rhinosinusitis‐related research. 28 , 45 , 49 …”

Multi-Disciplinary Expert Perspective on the Management of Type 2 Inflammation-Driven Severe CRSwNP: A Brief Overview of Pathophysiology and Recent Clinical Insights

“… 1 CRS is a clinical syndrome comprising a group of disorders with different phenotypes and degrees of severity. 2 Phenotypically, it is divided into CRS with nasal polyps (CRSwNP) and without (CRSsNP). 1 CRS has a multi-factorial etiology comprising alterations in mucociliary clearance, epithelial cell barrier abnormalities, and tissue remodeling.…”

“… 36 The importance of a multi-disciplinary approach has been underscored on a global scale by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) 38 , 39 and adapted by expert panels for various geographical regions, including Northern Europe 36 and the Gulf countries. 2 …”