Guidance for contemporary use of biologics in management of chronic rhinosinusitis with nasal polyps: discussion from a National Institutes of Health–sponsored workshop

Abstract

Background Biologic medications are emerging as options for treating chronic rhinosinusitis with nasal polyps (CRSwNP). Several questions remain regarding patient selection, indications, clinical efficacy, and cost effectiveness. Methods In November 2019, a group of physicians and scientists gathered to consider strategies for future studies regarding biologics. During the discussion, gaps in knowledge highlighted a need for a consensus on the present day use of biologics in polyp patients. Results The goal of this guideline is to propose recommendations for the current use of biologics in CRSwNP as new evidence continues to emerge and inform practice. Conclusion We suggest that physicians evaluate patients on an individual basis and closely monitor for improvement due to the high cost and unknown long‐term effects of biologics.

Biologics for severe uncontrolled chronic rhinosinusitis with nasal polyps: a change management approach. Consensus of the Joint Committee of Italian Society of Otorhinolaryngology on biologics in rhinology

“…The same criteria were adopted by EPOS 2020 1 . Initially authors 86 agreed that the first evaluation should be set at 4 months to consider an early stopping point if treatment response is lacking, due to the high cost of these medications. More recently, the EUFOREA expert panel in 2020 19 prolonged the first evaluation to 6 months of treatment and specified cut-offs for each criterion.…”

Olfactory cleft mucus inflammatory proteins in CRS: a case‐control study

“…This has direct clinical relevance, especially in the era of targeted biologic therapies. 7,23,24 Prior studies of dupilumab, an IL4/13 antagonist, report a mean improvement in NP score of approximately 2 points on an 8-point scale for the entire cohort. 25 In responder analyses, 45% of patients improve by 2 points or more, whereas nearly one-half of all patients do not improve or only improve by 1 point.…”

The Role of Biologics in Chronic Rhinosinusitis With Nasal Polyps

“…Recommendations by a National Institutes of Health-sponsored workshop and the European Forum for Research and Education in Allergy and Airway Disease (EUFOREA) have provided recommendations on incorporating biologic therapy into care pathways. 30,40 The EUFOREA recommendations provide guidance on patient selection for biologics based on the history of sinonasal surgery already performed or not. If a patient has had no history of surgery, then the patient should meet 4 of the following criteria (or 3 criteria if there is a history of surgery): (1) evidence of T2 inflammation, (2) 2 or more courses of corticosteroids in the past 1 year, (3) significantly impaired quality of life, (4) significant loss of smell, and (5) diagnosis of comorbid asthma.…”