Guideline for the use of immunobiologicals in chronic rhinosinusitis with nasal polyps (CRSwNP) in Brazil

Brazilian guideline for the use of immunobiologicals in chronic rhinosinusitis with nasal polyps ‒ 2024 update

“…In this section, we will outline the updates associated with the effect of biologicals on the olfaction of patients with CRSwNP since the last edition of these Guidelines. 140 In addition, we will discuss the criteria related to this sense, both for the prescription of these drugs and for the continuation of their use after the start of treatment.…”

Management of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in the Pan-Arab Region: Consensus Recommendations from a Multidisciplinary Expert Working Group

“…Dupilumab is a human monoclonal IgG4 antibody targeting the IL-4Rα subunit on the IL-4 and IL-13 receptor complexes, with inhibition of IL-4 and IL-13 signaling leading to reduced IgE production and eosinophil recruitment. 28 , 29 , 52 Omalizumab is a human monoclonal IgG1 antibody that binds the Fc region of circulating IgE, so blocking IgE interaction with mast cells, basophils and B-cells and reducing IgE production, and also by a direct effect on IgE B-cell production. 29 Mepolizumab (human monoclonal IgG1 antibody) binds circulating IL-5, with inhibition of IL-5 interaction with the α-chain on the IL-5 receptor on eosinophils, and downstream inhibitory effects on eosinophil maturation, recruitment and survival.…”

“… 29 Mepolizumab (human monoclonal IgG1 antibody) binds circulating IL-5, with inhibition of IL-5 interaction with the α-chain on the IL-5 receptor on eosinophils, and downstream inhibitory effects on eosinophil maturation, recruitment and survival. 29 , 52 …”

“…29 Mepolizumab (human monoclonal IgG1 antibody) binds circulating IL-5, with inhibition of IL-5 interaction with the α-chain on the IL-5 receptor on eosinophils, and downstream inhibitory effects on eosinophil maturation, recruitment and survival. 29,52 Biologics are now established in current guidelines for the treatment of severe uncontrolled CRSwNP. 2,3,[12][13][14]36 Although the positioning of biologics in the treatment of CRSwNP continues to evolve, the EPOS 2020 guidelines principally recommend use of biologics for those patients with CRSwNP refractory to routine medical therapy, and where disease persists despite previous ESS (although biologics can also be considered in those patients where patients may be unfit for ESS).…”

Chronic rhinosinusitis with nasal polyps: changing expectations

“…Although there is justifiable resistance and concern about financial aspects due to the current high cost of these medications, mature decisions will only be viable in the face of cost-effectiveness studies. 3 Evaluations where surgery as a comparison modality should at least expose the limits of the ethmoid, biologics could be used in different dosage proposals, and the costs associated with the long-term adverse effects of abused oral corticosteroids among these patients should also be weighed up. All this is within the irreversible principle of so-called precision medicine.…”