The Role of Biologics in Chronic Rhinosinusitis With Nasal Polyps

Abstract

Biologic therapy is a new treatment option for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Currently, the only biologic with Food and Drug Administration–approval status for CRSwNP is dupilumab. Several other biologics are likely to be approved for CRSwNP, including mepolizumab and omalizumab, based on their promising phase 3 trial results. The role of biologics in the treatment paradigm requires consideration of multiple factors that have yet to be clearly established. This includes identifying patients most appropriate for biologic therapy while considering long-term safety and cost-effectiveness in the context of patient preferences and goals.

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

“…Multiple factors have to be considered for the selection of biologics in the treatment of CRSwNP, including disease severity, risk of polyp recurrence with medical or surgical treatment, patient preferences and goals, safety, and cost-effectiveness. 32 Dupilumab is the first drug approved by the United States Food and Drug Administration (US FDA) followed by omalizumab to treat adults with CRSwNP. 31 Various studies that assessed the efficacy of dupilumab and omalizumab are detailed in Table 5 .…”

“…31 Various studies that assessed the efficacy of dupilumab and omalizumab are detailed in Table 5 . 32 …”

“…Table 4 Clinical Guidelines for the Management of CRSwNP Canadian Guidelines 30 The following treatment approaches are recommended: Further, patients who have recurrence despite surgery and patients who want to avoid surgery or are not eligible for surgery may benefit from a biologic agent. 32 The EPOS guidelines have also developed a paradigm for the response to biologic treatment. The following parameters or criteria are assessed after 16 weeks and after one year for evaluation of treatment response: reduced nasal polyp size, reduced need for systemic corticosteroids, improved quality of life, improved sense of smell, and reduced impact of comorbidities.…”

Are biologics for chronic rhinosinusitis effective and safe?

“…Chronic rhinosinusitis (CRS) refers to inflammation of the nasal sinuses and mucosa, with persistence of sinus inflammation and clinical manifestations beyond 12 weeks 1 . CRS affects between 6 and 12% of adults and is a cause of reduced quality of life (QoL) and high healthcare costs 2 . Management consisted of topical and systemic glucocorticoids, antibiotics and often repeated sinus surgery.…”

“…1 CRS affects between 6 and 12% of adults and is a cause of reduced quality of life (QoL) and high healthcare costs. 2 Management consisted of topical and systemic glucocorticoids, antibiotics and often repeated sinus surgery. Over the past 20 years, biologic therapies under investigation for asthma, with overlapping nasal polyposis, have shown significant improvement in sinonasal CRS symptoms and reduced nasal polyp swelling.…”