Current Treatments

Management of chronic rhinosinusitis with nasal polyps (CRSwNP) can be a challenge. Grade A evidence for initial management of CRSwNP includes the use of nasal saline irrigations for initial and maintenance therapy and macrolide antibiotics and systemic steroids for acute exacerbations.1,2 The initial management of CRSsNP is described below.3–5

However, the success rate of initial medical management for patients with CRSwNP is 50%; with the failure of medical management, surgical intervention is indicated, including functional endoscopic sinus surgery (FESS).6 Surgical therapy functions to remove polyposis and inflammatory tissue and to improve topical delivery of medications. Surgical intervention is not curative but rather is a means to improve medical management.7

Patients with severe or refractory disease following surgery who require repeat courses of systemic corticosteroids and/or have comorbid inflammatory conditions such as asthma have the highest unmet clinical need and are good candidates for biologic therapies.8–11

FDA-approved biologics
Dupilumab11,12

  • Inhibitor of interleukin (IL)-4 receptor alpha
  • Prevents downstream type 2 inflammation by blocking the shared receptor for IL-4 and IL-13 signaling
  • Approved in June 2019 for CRSwNP in adult patients
  • Phase 3 studies in CRSwNP: LIBERTY NP SINUS series

Mepolizumab11,13

  • Monoclonal antibody against IL-5
  • Binds to free IL-5, thereby preventing the IL-5 signaling cascade that promotes eosinophil activation and recruitment
  • Approved in July 2021 for CRSwNP in adults 18+
  • Phase 3 studies in CRSwNP: SYNAPSE series

Omalizumab11,14

  • Anti-IgE monoclonal antibody that binds to circulating immunoglobulin (Ig) E
  • Blocks the binding of IgE to the high-affinity receptor for the crystallizable fragment region of IgE (FcεRI) on the surface of mast cells and basophils to decrease inflammatory mediators
  • FDA approved in December 2020 for the treatment of NPs in adults 18+
  • Phase 3 studies in CRSwNP: POLYP series

References

  1. Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(suppl S29):1-464.
  2. Orlandi RR, Kingdom TT, Smith TL, et al. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021;11:213-739.
  3. Orlandi RR, Kingdom TT, Hwang PH. International consensus statement on allergy and rhinology: rhinosinusitis executive summary. Int Forum Allergy Rhinol. 2016;6(suppl 1):S5-S21.
  4. Akdis CA, Bachert C, Cingi C, et al. Endotypes and phenotypes of chronic rhinosinusitis: a PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2013;131:1479-1490.
  5. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(2suppl):S1-S39.
  6. Lam K, Kern RC, Luong A. Is there a future for biologics in the management of chronic rhinosinusitis? Int Forum Allergy Rhinol. 2016;6:935-942.
  7. Hull BP, Chandra RK. Refractory chronic rhinosinusitis with nasal polyposis. Otolaryngol Clin North Am. 2017;50:61-81.
  8. Patel GB, Peters AT. The role of biologics in chronic rhinosinusitis with nasal polyps. Ear Nose Throat J. 2021;100:44-47.
  9. Bachert C, Bhattacharyya N, Desrosiers M, Khan AH. Burden of disease in chronic rhinosinusitis with nasal polyps. J Asthma Allergy. 2021;14:127-134.
  10. Agache I, Song Y, Alonso-Coello P, et al. Efficacy and safety of treatment with biologicals for severe chronic rhinosinusitis with nasal polyps: A systematic review for the EAACI guidelines. Allergy. 2021;76:2337-2353.
  11. Borish L, Baroody FM, Kim MS, et al. Yardstick for the medical management of chronic rhinosinusitis. Ann Allergy Asthma Immunol. 2022;128:118-128.
  12. Dupilumab (Dupixent®) prescribing information (PI), 2022 www.regeneron.com/downloads/dupixent_fpi.pdf
  13. Mepolizumab (Nucala®) PI, 2022 https://gskpro.com/content/dam/global/hcpportal/en_US/Prescribing_Information/Nucala/pdf/NUCALA-PI-PIL-IFU-COMBINED.PDF
  14. Omalizumab (Xolair®) PI, 2021 www.gene.com/download/pdf/xolair_prescribing.pdf

Scientific Council

Neil M. Bressler, MD

James P. Gills Professor of Ophthalmology
Professor of Ophthalmology, Johns Hopkins University School of Medicine
Wilmer Eye Institute, Johns Hopkins Medicine
Baltimore, MD

A. Paul Chous, MA, OD, FAAO

Specializing in Diabetes Eye Care & Education, Chous Eye Care Associates
Adjunct Professor of Optometry, Western University of Health Sciences
AOA Representative, National Diabetes Education Program
Tacoma, WA

Steven Ferrucci, OD, FAAO

Chief of Optometry, Sepulveda VA Medical Center
Professor, Southern California College of Optometry at Marshall B. Ketchum University
Sepulveda, CA

Julia A. Haller, MD

Ophthalmologist-in-Chief
Wills Eye Hospital
Philadelphia, PA

Allen C. Ho, MD, FACS

Director, Retina Research
Wills Eye Hospital
Professor and Chair of the Department of Ophthalmology
Thomas Jefferson University Hospitals
Philadelphia, PA

Charles C. Wykoff, MD, PhD

Director of Research, Retina Consultants of Houston
Associate Professor of Clinical Ophthalmology
Blanton Eye Institute & Houston Methodist Hospital
Houston, TX

Copyright © 2020 | CLEAR Initiative | All Rights Reserved | Website by Divigner

CLEAR Initiative

Chronic rhinosinusitis with nasal polyplosis (CRSwNP) is a chronic inflammatory disease of the nasal mucosa and paranasal sinuses that is associated with significant morbidity and reduced quality of life.

The pathophysiology of CRSwNP is associated with local and systemic inflammation, with ongoing symptoms of nasal congestion, rhinorrhea, and loss of smell. These symptoms result in a significant burden on patients.

As one of the most common medical conditions in the US, CRSwNP has a predominately type 2 inflammatory endotype. It is typically treated with medical management consisting of inhaled corticosteroids, oral corticosteroid bursts, and saline irrigation. Leukotriene antagonists and antibiotics are also used, and if medical management fails, surgical intervention is typically chosen. Additionally, biologics that target type 2 inflammation are now available. These have been or will be approved for use in these patients.

Our CLEAR program is an online tool that aims to provide clinicians and patients with up-to-date information on the presentation, prognosis, pathophysiology, and treatment strategies for individuals with CRSwNP. Our goal is to provide information that empowers clinicians and patients to speak openly about treatment decisions and improve the standard of care for patients with this challenging disease.

Thank you for visiting our website. We invite you to explore the Clinician Toolkit and Patient Toolkit links as well as our pages on CME events, a poster portal to create your own poster, links to animated videos, and much more!

This activity is provided by Med Learning Group. This activity is co-provided by Ultimate Medical Academy/Complete Conference Management (CCM).
This activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc. and Sanofi.

Copyright © 2019 | CLEAR Initiative | All Rights Reserved | Website by Divigner

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