The role of biologics in chronic rhinosinusitis: a systematic review

Abstract

Background Chronic rhinosinusitis (CRS) refractory to medical and surgical treatment is challenging. It impacts patients’ quality of life significantly. The pathophysiology of CRS has some similarities to allergic asthma and allergic rhinitis (AR) and includes eosinophilia, T‐helper cell 2 cytokines, and local immunoglobilin E formation. Monoclonal antibody therapy has been used successfully in asthma and AR and more recently in CRS. Our was aim to systematically review the literature and identify the role of monoclonal antibodies (MAbs) in the treatment of CRS with polyps (CRSwNP) and without polyps (CRSsNP), especially with regard to comparability with current medical treatment, efficacy, and risk of complications. In addition, the role of surgery and biologics was evaluated. Methods We identified at total of 5341 relevant studies after a comprehensive database search. Six studies met the inclusion criteria, all 6 randomized, controlled trials. Results Treatment with omalizumab and mepolizumab demonstrated improvements in endoscopic nasal polyp score (EPS) and symptoms score in patients with CRSwNP when compared with placebo. Reslizumab reduced nasal polyp size in patients with raised intranasal interleukin‐5 levels. Dupilumab treatment resulted in a 70% reduction in EPS compared with 20% in the placebo group (p < 0.001). These MAbs target different inflammatory markers involved in the pathophysiology of CRSwNP. None of the studies reported on CRSsNP or combined surgery with biologics. No severe adverse events were reported. Conclusion Evidence demonstrates that use of MAbs leads to clinical improvement in CRSwNP. However, further research is required to determine their long‐term effects, comparability to other medical treatments, and potential side effects.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…Another treatment option for recalcitrant disease includes in‐office placement of drug eluting implants 289 . Most recently, biologics have shown promising results for the treatment of recalcitrant CRS, although long term follow‐up studies are ongoing 290,291 . The cost‐effectiveness studies for revision surgery, implants, and biologics for these CRS patients with recalcitrant disease is needed 292 …”

Modern approaches to the treatment of chronic polypous rhinosinusitis

“…However, due to the high risk of injuries from these methods, conservative therapy (with antibiotics and glucocorticosteroids) is now used (Bulfamante et al 2019). Treatment of CPR should begin with the eradication of the pathogen, considering the resistance of the micro-organism and the pharmacological effect of antibiotics (Feshchenko et al 2016;Grayson et al 2019;Iqbal et al 2020). Currently (according to the Eurasian Clinical Recommendations 2016, which are still currently), antibiotics used for the treatment of infectious diseases of the upper respiratory tract are usually divided into 3 lines of therapy (Song et al 2019):…”

Surgical outcomes in aspirin‐exacerbated respiratory disease without aspirin desensitization

“…More recently, monoclonal antibody therapy (MAT), such as omalizumab, mepolizumab, benralizumab, and dupilumab, has become increasingly popular as a new treatment option in the management of recalcitrant nasal polyps, including AERD 9,10 . Although the beneficial effects of MAT in patients with CRSwNP have been demonstrated in a small number of trials in terms of reducing the number of polyps and the need for surgery or corticosteroid therapy, the impact of these therapies in patients with AERD is less well established 11‐15 .…”