Currently, 4 biologics targeting type2 inflammatory mechanisms have been approved for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and available in many Western countries, i.e. omalizumab, mepolizumab, benralizumab, and dupilumab. Their future positioning and use as non-surgical treatment for CRSwNP will heavily rely on their cost-effectiveness. “For a more accurate assessment of cost-effectiveness, both direct and indirect costs should be included in health-economic evaluations (including risks and side effects of current treatment options: corticosteroids and surgery) as well as concurrently treated comorbidities (e.g. asthma),” Prof. Lars-Olaf Cardell (Karolinska Institute, Sweden) explained.
A review by Patel et al., which involved omalizumab (n=12), mepolizumab (n=42), benralizumab (n=44), reslizumab (n=6), and dupilumab (n=61), demonstrated that type2–targeting biologics can reduce the use of medication (corticosteroids/antibiotics) for acute exacerbations of chronic rhinosinusitis (AECRS) in patients with asthma and CRSwNP (70% of patients) or chronic rhinosinusitis without nasal polyps (CRSsNP) (30% of patients). The estimated yearly rate for the use of systemic corticosteroids for AECRS decreased from 1.69 (95% CI 1.42–2.02) to 0.68 (95% CI 0.53–0.88), which translates into a reduction of 60% (P<0.001). The yearly rate for antibiotic use for AECRS following implementation of biologics decreased from 1.34 (95% CI 1.12–1.59) to 0.68 (95% CI 0.52–0.88); i.e. a 49% reduction (P<0.001). These findings suggest that these biologics may offer an effective therapeutic option for patients with type2 disease with frequent AECRS . In this respect, Prof. Cardell also referred to the EPOS 2020 treatment scheme for diffuse/bilateral type2 CRS in which type2 inflammation targeting biologics have been allocated as add-on treatment .
More explicit guidance on the use of biologics in CRSwNP has been recently defined by expert panels [2,3]. “In these patients, specific criteria are required and should be at least 3 of the following: evidence of type2 inflammation, the need for systemic corticosteroids or a contraindication to systemic steroids, significantly impaired quality of life, loss of smell, or a diagnosis of comorbid asthma.” Response to biological treatment in CRSwNP is defined by evaluation of 5 outcome criteria (i.e. reduced nasal polyp size, reduced need for systemic corticosteroids, improved quality of life, improved sense of smell, and reduced impact of co-morbidities). If a patient fits all 5 criteria, this is considered an excellent response; 3-4 criteria is moderate response, 1-2 criteria is defined as poor response, and 0 criteria equals no response [2–4].
- Patel G, et al. Allergy Asthma Proc. 2021;42:417-424.
- Fokkens WJ, et al. Rhinology. 2020 Apr 1;58(2):82-111.
- Hellings PW, et al. Rhinology 2020 Dec 1;58(6):618-622.
- Cardell L-O. CRSwNP and biologic treatment. Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark. Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark.
Copyright ©2022 Medicom Medical Publishers
« The ULANC Group: working together in CRSwNP/asthma Next Article
CRSwNP outlined »
Table of Contents: NLC 2022
NLC 2022 Highlights Podcast
Respiratory Disease and Physical Activity
Physical activity improves asthma control
Tailored exercise needed for COPD patients
Exercise training for IPF patients is feasible but access needs to be improved
Respiratory Disease and Reproduction
Asthma increases risks around delivery
PRO-ART study: unravelling the link between asthma and subfertility
Early-onset and uncontrolled asthma: strong association with recurrent pregnancy loss
Palliative Care in Respiratory Diseases
Advance care planning
Biologics in Asthma
Severe asthma in the spotlights
Common comorbidities in severe asthma
Treatable Traits in Obstructive Airway Diseases
Targeting treatable traits allows a personalised approach to management of (severe) asthma
Challenges in Upper Airway Diseases
Exercise-induced laryngeal obstruction (EILO) is often misdiagnosed
The role of biologics in CRSwNP
The ULANC Group: working together in CRSwNP/asthma
Interstitial Lung Diseases (ILD)
Rheumatoid arthritis-associated ILD
Thoracic ultrasound: a new diagnostic imaging tool in RA-ILD?
Update on treatment of fibrotic ILD
Lung Cancer Screening in the Nordics
Lung cancer screening in Denmark
Points of interest for radiologists screening for lung cancer
E-cigarettes impose detrimental effects on health
Effects of passive vaping in COPD patients
Vaping amongst adolescents: an alarming trend
Tuberculosis and Sarcoidosis
New antigens in sarcoidosis
Detection of latent TB infection key to preventing the spread of the disease
New antigens in sarcoidosis
Fatigue syndrome in sarcoidosis