Eosinophilic respiratory disorders and the impact of biologics

Abstract

Purpose of reviewEosinophils are involved in combating parasitic, bacterial, viral infections as well as certain malignancies. However, they are also implicated in an array of upper and lower respiratory disease states. Through a deeper understanding of disease pathogenesis, targeted biologic therapies have revolutionized glucocorticoid sparing treatment of eosinophilic respiratory diseases. This review will focus on the impact of novel biologics on the management of asthma, eosinophilic granulomatosis with polyangiitis, allergic bronchopulmonary aspergillosis (ABPA), hypereosinophilic syndrome (HES) and chronic rhinosinusitis with nasal polyposis (CRSwNP).Recent findingsKey immunologic pathways affecting Type 2 inflammation through immunoglobulin E (IgE), interleukin (IL-4), IL-5, IL-13, and upstream alarmins such as thymic stromal lymphopoietin (TSLP), have led to novel drug developments. We explore the mechanism of action for Omalizumab, Mepolizumab, Benralizumab, Reslizumab, Dupilumab, and Tezepelumab, their respective Food and Drug Administration (FDA) indications, and biomarkers affecting treatment decisions. We also highlight investigational therapeutics that are likely to impact the future management of eosinophilic respiratory diseases.SummaryInsight into the biology of eosinophilic respiratory diseases has been critical for understanding disease pathogenesis and has contributed to the development of effective eosinophil-targeted biologic interventions.

Predictors and Time Interval of Chronic Rhinosinusitis Recurrence After Endoscopic Sinus Surgery

“…Therefore, multiple biological agents (e.g., dupilumab, mepolizumab, and omalizumab) are now approved and recommended for recurrent CRSwNP. The introduction of these biological agents might improve the outcome of CRSwNP and decrease the need for revision ESS in patients with type 2 CRS, thus avoiding the risk of intraoperative complications ( 3 ). On the contrary, several studies showed a revision rate ranging between 11% to 27% in both CRSsNP and CRSwNP groups with no significant difference between both groups ( 7 , 12 , 14 ).…”

“…The type 2 immune response involves eosinophils, IgE, and upregulation of type 2 cytokines, constituting most of CRSwNP. On the other hand, non-type 2 CRS is primarily considered a type 1 to type 3 immune response and is characterized by neutrophilic inflammation in the nasal mucosa ( 3 ). The treatment goals in patients with CRS are directed to improve patients’ symptoms and quality of life.…”