Biologic Therapies in Chronic Rhinosinusitis
Introduction to Biologic Therapies
- The American Academy of Otolaryngology recommends considering biologic therapies for patients with chronic rhinosinusitis with nasal polyps (CRSwNP) who have failed conventional treatments 3
Efficacy and Safety of Biologic Therapies
- Dupilumab, omalizumab, and mepolizumab have been shown to be effective in reducing symptoms and improving quality of life in patients with CRSwNP, with response rates ranging from 40-70% 1, 3, 5
- The European Academy of Allergy and Clinical Immunology suggests that biologics may be considered for patients with CRSwNP who have comorbid asthma, with dupilumab showing promise in improving asthma control and lung function 3, 5
- Biologics have been associated with various adverse events, including conjunctivitis, injection site reactions, and systemic effects, with serious adverse event rates ranging from 0.8-5.9% 3
Predictive Biomarkers and Treatment Selection
- Baseline characteristics such as eosinophil counts, IgE levels, and polyp scores may predict treatment response to biologics, with a systematic review suggesting that tissue eosinophilia may be a better predictor of response than blood eosinophilia 3, 6
Combination and Sequential Therapy
- The use of biologics in combination with intranasal corticosteroids may provide additional benefit beyond biologics alone, with a systematic review suggesting that this combination may improve symptoms and quality of life in patients with CRSwNP 1, 3