Optimizing the timing of biologic and surgical therapy for patients with refractory chronic rhinosinusitis with nasal polyposis (CRSwNP)

Abstract

IntroductionChronic rhinosinusitis with nasal polyposis (CRSwNP) is often treated with endoscopic sinus surgery (ESS), however, patients may require revision surgery due to recurrence. To date, no studies have compared outcomes for combined surgery and biologic therapy for CRSwNP compared to biologic therapy alone.MethodsRetrospective case‐control study of CRSwNP patients who underwent ESS while on dupilumab or mepolizumab (ESS‐biologic cohort), compared to CRSwNP patients on biologic therapy (biologic‐only controls). Cohorts were matched according to indication, aspirin exacerbated respiratory disease (AERD), sinonasal outcome test‐22 (SNOT‐22), and total polyp scores.Results16 patients underwent ESS while on biologic therapy (13 dupilumab and 3 mepolizumab). 16 patients were biologic‐only controls. There were no significant differences between indication, baseline SNOT‐22 scores, polyp scores, and AERD status between cohorts. Patients underwent surgery a median of 33 days after starting biologic therapy. After 12 months of follow up, the total polyp score for the ESS‐biologic cohort decreased from 4.73 to 0.09, compared to biologic‐only controls 5.22 to 3.38 (95% CI of Difference: ‐5.37 to ‐1.38, Cohen's d: 2.40, p = 0.005). In the ESS‐dupilumab sub‐analysis, the ESS‐dupilumab cohort had a significant reduction in polyp burden 4.85 to 0.00 compared to controls 4.88 to 3.50 (95% CI of Difference: ‐5.68 to ‐1.32, Cohen's d: ‐1.69, p = 0.009).ConclusionIn CRSwNP patients, combined ESS and biologic therapy results in a significant and sustained decrease in polyp burden compared to biologic therapy alone. Larger studies are warranted to further examine the impact of combined therapy.This article is protected by copyright. All rights reserved

Brazilian guideline for the use of immunobiologicals in chronic rhinosinusitis with nasal polyps ‒ 2024 update

“…The robustness of these results was corroborated by Phase III trials and the sub-analyses of these studies, which revealed a significant increase in olfactory function after 24-weeks, although with a difference of 10.5 points between groups, regardless of confounding factors such as disease duration, previous surgeries, and concomitant respiratory conditions. 109 , 149 The baseline olfactory scores correlated with all measured local and systemic type 2 inflammatory markers, except for total serum immunoglobulin E. Real-life studies also reinforce the positive impact of dupilumab on olfaction. Significant improvement in olfactory function, even in patients with persistent polyps, was observed in a cohort of 53 patients using dupilumab.…”

“…The evaluations will consist of objective measures and various patient-reported questionnaires, treatment patterns, concomitant medications, long-term safety, and progression of CRSwNP, including those with coexisting diseases. 109 …”