Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition of the sinonasal cavities [1-3]. It is frequently comorbid with asthma and both diseases share common underlying pathophysiological mechanisms driving the disease, including type 2 inflammation [3-9].
CRSwNP severely impacts quality of life and has a significant burden on society [10-12]. When symptoms are persistent or when there is a long-term need for antibiotics or systemic steroids, it is considered uncontrolled disease [13-15]. The goal of CRSwNP management is clinical control with minimal use of medication or surgery, but this is challenging [16-19]. However, type 2 inflammation-targeting biologics have entered the market for selected pheno/endotypes of asthma and may soon become available for CRSwNP patients [20-21]. Omalizumab and other biologics (anti-IL5, anti-IL5R, and anti-Il4Rα) are effective for the treatment of asthma with a type 2 inflammatory signature [20-21]. The first studies with these biologics in CRSwNP have shown promising results and a positive impact on quality of life [22-25].
Careful selection of patients is highly recommended . The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) organised a multidisciplinary Expert Board Meeting to discuss the positioning of biologics into care pathways for CRSwNP patients with and without comorbid asthma. They have put forward 5 criteria for careful selection of patients to whom biologics should be prescribed (see Figure), as well as criteria to define the response to biological therapy after 1 year . It is likely that biologics will become a valid alternative to sinus surgery [25,27].
Figure: Indications for biological treatment in patients with CRSwNP: proposal of the multidisciplinary EUFOREA Expert Board Meeting (Modified from Fokkens et al )
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- Wei B, Liu F, Zhang J, et al. Multivariate analysis of inflammatory endotypes in recurrent nasal polyposis in a Chinese population. Rhinology. 2018;56(3):216‐226.
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- Bachert C, Zhang L, Gevaert P. Current and future treatment options for adult chronic rhinosinusitis: focus on nasal polyposis. J Allergy Clin Immunol. 2015;136(6):1431‐1440.
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- Bachert C, Mannent L, Naclerio RM, et al. Effect of subcutaneous dupilumab on nasal polyp burden in patients with chronic sinusitis and nasal polyposis: a randomized clinical trial. JAMA 2016;315(5):469‐479.
- Bachert C, Sousa AR, Lund VJ, et al. Reduced need for surgery in severe nasal polyposis with mepolizumab: randomized trial. J Allergy Clin Immunol. 2017;140(4):1024‐1031.e14.
- Fokkens WJ, Lund V, Bachert C, et al. EUFOREA consensus on biologics for CRSwNP with or without asthma. Allergy. 2019;74:2312–2319
- Bidder T, Sahota J, Rennie C, Lund VJ, Robinson DS, Kariyawasam HH. Omalizumab treats chronic rhinosinusitis with nasal polyps and asthma together‐a real life study. Rhinology. 2018;56(1):42‐45.
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