Perspectives in Therapy of Chronic Rhinosinusitis

Abstract

The recent classification of chronic rhinosinusitis (CRS) focusses on investigating underlying immunopathophysiological mechanisms. Primary CRS is subdivided based on endotype dominance into type 2 (that relates mostly to the Th2 immune response with high levels of IL-5, IL-13, and IgE), or non-type 2 (that corresponds to the mix of type 1 and type 3). The treatment selection of CRS is dependent on endotype dominance. Currently, the majority of patients receive standardized care—traditional pharmacological methods including local or systemic corticosteroids, nasal irrigations or antibiotics (for a selected group of patients). If well-conducted drug therapy fails, endoscopic sinus surgery is conducted. Aspirin treatment after aspirin desensitization (ATAD) with oral aspirin is an option for the treatment in nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) patients. However, in this review the focus is on the role of biological treatment—monoclonal antibodies directed through the specific type 2 immune response targets. In addition, potential targets to immunotherapy in CRS are presented. Hopefully, effective diagnostic and therapeutic solutions, tailored to the individual patient, will be widely available very soon.

Biologics for Chronic Rhinosinusitis—A Modern Option for Therapy

“…Common Th-2 immune pathway is the reason for most of the biologics developed for asthma being effective in CRSwNP. Biologic treatment can be used in CRSwNP patients meeting the eligibility criteria [13]. EPOS 2020 has made indications for the biological treatment of CRSsNP and established the criteria used for the evaluation of the efficiency assessment of biologic therapy.…”

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

“…Gene therapy is an emerging frontier in managing CRSwNP. While biologics like monoclonal antibodies have shown promise in alleviating symptoms such as nasal blockage and impaired sense of smell, as well as reducing polyp size, there are limitations to conventional treatment approaches, notably the recurrence of NP [ 58 , 59 ]. Recent research has unveiled several potential therapeutic targets for CRSwNP, including variations in the thymic stromal lymphopoietin gene that exhibit an association with CRSwNP dependent on gender and the presence of NP [ 60 ].…”

Rinossinusite Crônica - aspectos fisiopatológicos e manejo terapêutico

“…Outrossim, antibióticos são frequentemente prescritos, mas sua utilidade é controversa devido à falta de ensaios clínicos bem desenhados. Alguns estudos sugerem que antibióticos a longo prazo podem ser benéficos, especialmente para pacientes com inflamação tipo 3, mas as evidências são limitadas (PATEL et al, 2020;BRZOST et al, 2022).…”

“…Em geral, o tratamento da RSC é personalizado com base nas necessidades individuais do paciente e nas características da doença. Mais pesquisas são necessárias para determinar a eficácia de diferentes abordagens terapêuticas e identificar as melhores opções para cada subtipo de RSC (PATEL et al, 2020;BRZOST et al, 2022).…”

“…De forma tradicional, a RSC é classificada a partir do seu fenótipo, subdividido pela presença ou ausência de pólipos nasais associados. Contudo, estudos recentes buscam avaliá-la através do seu mecanismo fisiopatológico, diferenciando-a pelo endotipo tipo 2, relacionado a resposta imune Th2 classicamente atribuída ao mecanismo alérgico da patologia; ou não tipo 2, que corresponde ao perfil clínico com perfil Th1 e Th3 associados, os quais apresentam menor resposta ao tratamento convencional (MARCUS et al, 2019;PATEL et al, 2020;BRZOST et al, 2022).…”