Biologicals and Endoscopic Sinus Surgery for Severe Uncontrolled Chronic Rhinosinusitis With Nasal Polyps: An Economic Perspective

Lans, Rik Jl van der; Hopkins, Claire; Senior, Brent A.; Lund, Valerie J.; Reitsma, Sietze

doi:10.1016/j.jaip.2022.02.017

Cited by 38 publications

(18 citation statements)

References 41 publications

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“…19,[32][33][34]52,53 Real-world evidence and practice will further mold currently deployed treatment strategies to advance patient selection, preferred therapy, and cost efficacy to enable durable employment of this yet costly modality. 27,54 The swift and enduring improvements achieved by tapered dupi-…”

Section: Advancement Of the Interdose Interval Tapering From 24 Weeksmentioning

confidence: 99%

“…Cost efficacy is a focal point in general for the implementation and use of often effective yet costly biological treatments, with importance to all stakeholders. 54,65 It has been evaluated in other diseases on the forefront of this modalities' implementation, like rheumatoid arthritis, psoriasis, and-more closely related-asthma and atopic dermatitis. Various cost-effectiveness ratios result, and gaps in evidence call for sectoral and generalized cost-effectiveness analyses, including the real-world perspective.…”

Section: 9mentioning

confidence: 99%

“…[66][67][68][69][70] Although formal cost efficacy evaluation of dupilumab for CRSwNP needs be performed, direct costs are likely substantially higher compared to conventional non-biological therapy, because of the acquisition costs of dupilumab. 54 For the Dutch situation, acquisition costs of dupilumab is € 16.3500/year/patient for the dupilumab alone. 71 The reduction in dosing frequency is directly proportional to the costs of the dupilumab, meaning cost reduction up to 25% of the applicable pricing is achievable based on Q8W (€ 4.087).…”

Section: 9mentioning

confidence: 99%

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Two‐year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months

Lans

Otten

Adriaensen

et al. 2023

Allergy

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BackgroundDupilumab is an anti‐T2‐inflammatory biological registered for chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), indicated by integrated CRS‐care pathways when optimal medico‐surgical treatment yields insufficient CRS control. This study aims to evaluate long‐term results with focus on established therapeutic efficacy while tapering dupilumab.MethodsReal‐life, prospective observational cohort study in single tertiary referral center with add‐on dupilumab as primary biological treatment in adult (≥18 years) biological‐naïve CRSwNP patients per the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS)2020‐indication with a 2‐year follow‐up. Tapering (increasing interdose interval) applied every 24 weeks, conditional to sufficient treatment response and CRS control.ResultsMean scores (s.d.) of all co‐primary outcomes improved significantly from baseline ( 228) to the 48 ( 214) and 96‐weeks ( 99) timepoints: Nasal Polyp Score (0–8) improved from 5,3 (1,9) to 1,4 (1,8) and 1,3 (1,7); SinoNasal Outcome Test (SNOT)‐22 (0–110) improved from 53,6 (19,6) to 20,2 (15,4) and 21,2 (15,6); Sniffin’Sticks‐12 identification test (0–12; 0–6 anosmia, 7–10 hyposmia, 11–12 normosmia) improved from 3,7 (2,4) to 7,7 (2,9) and 7,3 (3,04); Asthma Control Test (5–25; >19 indicating well‐controlled asthma) improved from 18,5 (4,8) to 21,8 (3,8) and 21,4 (3,9). Tapering was feasible in 79,5% of the patients at the 24‐weeks timepoint, and in 93,7% and 95,8% at the 48‐ and 96‐weeks timepoints, respectively. One‐way repeated‐measures ANOVA demonstrated no significant alterations of individual co‐primary outcome mean‐scores from 24 weeks onward.ConclusionThis first long‐term real‐life prospective observational cohort study shows high therapeutic efficacy of dupilumab for severe CRswNP in the first 2 years. Therapeutic efficacy is principally established within 24 weeks and endures while tapering dupilumab conditional to treatment response and CRS control.

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Section: Advancement Of the Interdose Interval Tapering From 24 Weeksmentioning

confidence: 99%

Section: 9mentioning

confidence: 99%

Section: 9mentioning

confidence: 99%

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Two‐year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months

Lans

Otten

Adriaensen

et al. 2023

Allergy

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“…Biologics face the greatest criticism of their cost and positioning in CRSwNP treatment strategies depending on cost‐effectiveness 22,23 . A real‐world study found that around one fifth of the asthmatics discontinued biological therapy in light of the heavy financial burden 24 .…”

Section: Discussionmentioning

confidence: 99%

Comparative short‐term efficacy of endoscopic sinus surgery and biological therapies in chronic rhinosinusitis with nasal polyps: A network meta‐analysis

Chen,

Wang,

Zhang

et al. 2023

Clinical & Translational All

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Background: To compare the safety and efficacy between endoscopic sinus surgery and different biologics in treating chronic rhinosinusitis with nasal polyps in adults by reviewing the existing clinical trials.Methods: Data extraction and risk of bias assessment were conducted by 2 independent reviewers according to the PRISMA recommendations and any disagreement was resolved by a third investigator. Outcomes were measured through a random-effects model. We searched Embase, Web of Science, MEDLINE, Cochrane, and other relevant sources from its inception to April 30, 2022. We included randomized controlled trials(RCTs) involving endoscopic sinus surgery (ESS) or biologics in treating adult patients with chronic rhinosinusitis with nasal polyps. Studies involving other miscellaneous diseases, non-RCT design, and insufficient participants or follow-up were excluded. Results:In this systematic review, five RCTs and 1748 patients were included. All the biologics, as well as ESS, could significantly improve key nasal outcomes in CRSwNP both at 6 months and 1 year. Dupilumab exhibited better efficacy than ESS in improving SNOT-22 scores at one year. However, ESS showed superiority over three biologics in improving nasal congestion scores (NCS) at two various time points, except for better efficacy of Dupilumab at 1 year. For the loss of smell scores, a greater improvement was observed in the Dupilumab cohort compared with other biologics and even ESS counterparts. Safety analysis showed no significant difference between the ESS cohort and biologic treatment. Conclusions:In summary, ESS showed comparable improvement in quality of life and symptoms to Omalizumab, Mepolizumab, and Benralizumab. Dupilumab seems to be more effective than ESS in selected items, whereas head-to-head trials and real-world studies are urgent to compare their efficacy. Our findings also showed Jiani Chen and Huan Wang are contributed equally to this work.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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“…In real life, polyps often disappear after treatment with biological in most patients (2) . However, the treatment is very costly (3) . In this issue of our Journal, Prof Claire Hopkins discusses the ethical dilemma's of prescribing such an expensive treatment.…”

Section: Unmet Needs In Biological Treatment Of Crsmentioning

confidence: 99%

Unmet needs in biological treatment of CRS

Fokkens¹

2022

Rhin

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Biologicals and Endoscopic Sinus Surgery for Severe Uncontrolled Chronic Rhinosinusitis With Nasal Polyps: An Economic Perspective

Cited by 38 publications

References 41 publications

Two‐year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months

Two‐year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy established in the first 6 months

Comparative short‐term efficacy of endoscopic sinus surgery and biological therapies in chronic rhinosinusitis with nasal polyps: A network meta‐analysis

Unmet needs in biological treatment of CRS

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