Chronic rhinosinusitis with nasal polyps: how to identify eligible patients for biologics in clinical practice

Gelardi, Matteo; Bocciolini, Corso; Notargiacomo, Mario; Schiavetti, Irene; Lingua, Cristiano; Pecoraro, Pietro; Iannuzzi, Lucia; Quaranta, Vitaliano Antonio; Giancaspro, Rossana; Ronca, Gianluca; Cassano, Michele; Ciprandi, Giorgio

doi:10.14639/0392-100x-n1699

Cited by 8 publications

(5 citation statements)

References 24 publications

(33 reference statements)

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“…Among the factors responsible for recurrence after endoscopic sinus surgery are high levels of eosinophil cationic protein, high anti-double-stranded DNA IgG, high IL-5, high modified Lund-Mackay radiographic score and asthma [83]. There is still the question regarding the dimensions of the polyps and the level of polyposis that is still responding to the action of biological treatments [84]. The ultimate goal is the increase in the quality of life of the patient with chronic allergic rhinosinusitis [85].…”

Section: Future Clinical Directionsmentioning

confidence: 99%

Biologics for Chronic Rhinosinusitis—A Modern Option for Therapy

Cergan,

Berghi,

Dumitru

et al. 2023

Life

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Chronic rhinosinusitis (CRS) is an important ENT pathology which affects about 5–12% of the general population. The treatment of CRS can be pharmacological (nasal sprays, douches, systemic antibiotics and steroids), surgical (endoscopic sinus surgery) or immunological according to established algorithms. CRS was divided for many years into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). New ways of classifying CRS by endotypes (presence of neutrophilia, eosinophilia, fibrosis, glandular hypertrophy and epithelial dysmorphisms) appeared after the most recent understandings of the pathophysiology of the disease. Other classifications divide CRS into primary and secondary forms, localized/diffuse types and anatomical presentation. A new type of treatment has been administered in the last years, biologics. For the moment, biologics are indicated just in the cases of the patients who have undergone ESS or have contraindications for surgery and have bilateral polyps and meet a minimum of three of the following criteria: the necessity for systemic therapies with oral or parenteral corticosteroids or contraindications to systemic steroids, significant loss of smell or impaired QoL score, comorbid asthma and type 2 inflammation. This article aims to present the most relevant studies which used the three types of biologics (anti-IgE, anti-IL5 and anti-IL4/IL3) and wishes to increase the awareness of this new type of treatment that can be used in some CRS cases.

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Section: Future Clinical Directionsmentioning

confidence: 99%

Biologics for Chronic Rhinosinusitis—A Modern Option for Therapy

Cergan,

Berghi,

Dumitru

et al. 2023

Life

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“…Another strength is that the burden of sinonasal symptoms is not confounded by nasal polyps which is a different phenotype of chronic rhinosinusitis and known to be associated with sinonasal symptoms. 50 Finally, blinding of the otolaryngologist for the presence of sinonasal symptoms and the severity of airflow limitation reduces the risk of bias concerning the outcome of the nasal endoscopic examination and hence the clinical diagnosis of RSsNP. Some limitations should also be addressed.…”

Section: Discussionmentioning

confidence: 99%

Sinonasal Symptoms in COPD: Burden and Associations with Clinical Markers of Disease

Øie¹,

Helvik²,

Sue‐Chu³

et al. 2022

COPD

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Purpose Sinonasal symptoms are prevalent in COPD, and knowledge of the relationship between these symptoms and clinical markers of COPD is limited. This study explores the associations between the burden of sinonasal symptoms and clinical markers and thresholds recommended for guiding treatment decisions in the GOLD guidelines. Patients and Methods Sinonasal symptoms were quantified with the rhinological subscale of the Sino-Nasal-Outcome-Test (SNOT-22) in 93 COPD patients characterized by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2012 diagnostic criteria for rhinosinusitis without nasal polyps (RSsNP). Associations between a high burden, defined as a SNOT22_rhinological score of ≥11, and the following markers were assessed by adjusted multivariable linear regressions; severity of dyspnea [modified Medical Research Council (mMRC)] and cough [Visual Analogue Scale (VAS)], physical activity [6-minute walking distance (6MWD)], mortality risk (BODE index), and HRQoL [disease-specific COPD Assessment Test (CAT) and St. Georges Respiratory Questionnaire (SGRQ), and physical component summary, Short Form-36 version 2.0 (PCS SF-36v2)]. Odds ratios for the association of a high burden and threshold levels for regular treatment were estimated by adjusted binomial logistic regression models. Results A high burden was associated with greater severity of dyspnea and cough, lower 6MWD, higher BODE index and poorer HRQoL. The odds ratio of having CAT and SGRQ scores that are above the thresholds recommended for treatment was 5–7-fold greater in the high burden group. Conclusion A high burden of sinonasal symptoms is positively associated with the clinical markers of symptom severity and mortality risk and is inversely associated with physical activity and HRQoL in COPD. These findings add further support that the UAD concept also applies to COPD. Enquiry about sinonasal symptoms in COPD patients should be incorporated into the clinical routine.

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“…To verify the putative clinical effects of the treatment with dupilumab in patients with CRSwNP, we firstly assessed specific diagnostic/prognostic scores such as SNOT-22 [ 15 ], NPS [ 16 ], and VAS [ 17 ]. All four patients showed a significant amelioration over time for all the evaluated scores (F = 11.74 and p = 0.0018 for SNOT-22, F = 6.11 and p = 0.0149 for NPS, F = 9.46 and p = 0.0038 for VAS), with a more pronounced reduction at T3 compared to baseline ( p < 0.01 for SNOT-22, p < 0.05 for NPS and VAS) ( Table 1 and Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

Spotlight on a Short-Time Treatment with the IL-4/IL-13 Receptor Blocker in Patients with CRSwNP: microRNAs Modulations and Preliminary Clinical Evidence

Mimmi

Lombardo

Maisano

et al. 2022

Genes

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Already used for the treatment of some allergic and inflammatory diseases, such as asthma or atopic dermatitis, dupilumab has also been approved as add-on therapy for patients with CRSwNP, and it could represent the keystone to reducing the remission time as well as to improve healing and quality of life. On the other hand, the role of miRNAs as potential biomarkers of immune modulation is emerging. We analyzed the effects of a short-time treatment with dupilumab in patients with CRSwNP, analyzing the immune response modification as well as miRNAs modulations. First, in this early observation stage, all patients experienced remarkable improvement and were clinically stable. Indeed, we observed a significant decrease in CD4+ T cells and a significant reduction in total IgE (p < 0.05) and serum IL-8 levels (p < 0.01), indicating a reduction in the general inflammatory condition. In addition, we analyzed a panel of about 200 circulating miRNAs. After treatment, we noted a significant downregulation of hsa-mir-25-3p (p-value = 0.02415) and hsa-mir-185-5p (p-value = 0.04547), two miRNAs involved in the proliferation, inflammation, and dug-resistance, in accordance with the clinical status of patients. All these preliminary data aimed to identify new biomarkers of prognosis, identifiable with non-invasive procedures for patients. Further, these patients are still under observation, and others with different levels of responsiveness to treatment need to be enrolled to increase the statistical data.

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Chronic rhinosinusitis with nasal polyps: how to identify eligible patients for biologics in clinical practice

Cited by 8 publications

References 24 publications

Biologics for Chronic Rhinosinusitis—A Modern Option for Therapy

Biologics for Chronic Rhinosinusitis—A Modern Option for Therapy

Sinonasal Symptoms in COPD: Burden and Associations with Clinical Markers of Disease

Spotlight on a Short-Time Treatment with the IL-4/IL-13 Receptor Blocker in Patients with CRSwNP: microRNAs Modulations and Preliminary Clinical Evidence

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