Survey on Use of Local and Systemic Corticosteroids in the Management of Chronic Rhinosinusitis with Nasal Polyps: Identification of Unmet Clinical Needs

Abstract

Background: Local and systemic corticosteroids have long been the workhorse in management of chronic rhinosinusitis with nasal polyps (CRSwNP), although there is no universally accepted modality of prescription. We carried out a survey in Italy to capture current trends in the use of topical and systemic corticosteroids in patients with CRSwNP. Methods: A survey was set up on Survey Monkey®. Each author distributed the link to the survey in an ad hoc manner and a total of 437 participants filled out the survey. Results: Mometasone furoate (79.3%) was the most frequently prescribed, administered daily by 61.9% of participants; the remaining preferred to discontinue treatment for brief periods to reduce side effects or to modulate the therapy in mild cases. The majority believe that a short cycle of systemic steroids should be prescribed for re-exacerbation of symptoms and that the number of cycles in the previous year should be evaluated to define control of the disease even if international guidelines do not provide clear indications on this topic. A certain degree of divergence emerged from responses regarding how long and the maximal dose of systemic steroids which place patients at high risk for adverse events. Finally, systemic corticosteroids seem to offer only temporary benefit on recovery of smell without guaranteeing long-term control even if the patient is adherent to topical corticosteroids. Conclusions: Our results highlight the need for clear guidelines on oral steroids, which could help supporting the use of a precision medicine approach, including indications for new biological agents.

Proposal for a Structured Outpatient Clinic for Dupilumab Treatment in Chronic Rhinosinusitis with Nasal Polyps in the First Year of Treatment

“…Our data confirm the effectiveness of dupilumab in a real-life setting: as already stated in our previous experience [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ], the results in real life seem to be better than the results in the trials.…”

“…In order to do so, each patient undergoes complete ENT assessment with rigid HD nasal video-endoscopy (with definition of the NPS [ 1 , 2 , 3 , 4 , 5 ]), SNOT-22 questionnaire [ 1 , 2 ], and sense-of-smell assessment [ 1 , 2 , 3 , 4 , 5 ]. Previous control of the disease by surgery or systemic corticosteroids was also assessed to evaluate eligibility for dupilumab treatment [ 12 , 13 ]. Computed-tomography (CT) scans (performed no more than 3 months earlier) are evaluated and the Lund–Mackay score (LMS) is defined [ 1 ].…”

Olfaction Recovery following Dupilumab Is Independent of Nasal Polyp Reduction in CRSwNP

“…The standard of care for CRSwNP, intranasal steroids (INS), and repeated bursts/short courses of systemic/oral steroids (OCS) do not provide a long-lasting recovery of olfaction in subjects with CRSwNP [ 5 ] In addition, little evidence about olfactory outcomes between medical and surgical management of CRSwNP exists [ 2 ]. For instance, patients who benefit from surgery presented improvement in olfaction by 1 month that decreased by 3 months after surgery [ 6 ].…”

Impact of Topical v/s Systemic Steroids on Regaining Olfaction in Post Covid-19 Patients; A Randomized Controlled Trail

“…On the other hand, topical steroids have been considered as safe but slow route in the treatment of nasal and local dermal infections. In covid-19, olfactory dysregulation could be treated with either systemic steroids or with topical steroids 11 .…”