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Review
. 2022 Feb;42(1):1-16.
doi: 10.14639/0392-100X-N1614. Epub 2021 Jul 23.

Biologics for severe uncontrolled chronic rhinosinusitis with nasal polyps: a change management approach. Consensus of the Joint Committee of Italian Society of Otorhinolaryngology on biologics in rhinology

Eugenio De Corso  1 , Gianluca Bellocchi  2 , Michele De Benedetto  3 , Nicola Lombardo  4 , Alberto Macchi  5 , Luca Malvezzi  6 , Gaetano Motta  7 , Fabio Pagella  8 , Claudio Vicini  9 , Desiderio Passali  10
Affiliations
Review

Biologics for severe uncontrolled chronic rhinosinusitis with nasal polyps: a change management approach. Consensus of the Joint Committee of Italian Society of Otorhinolaryngology on biologics in rhinology

Eugenio De Corso et al. Acta Otorhinolaryngol Ital. 2022 Feb.

Abstract

Biologici nel trattamento della poliposi naso-sinusale severa non controllata: cambiamento nelle strategie terapeutiche. Consensus dei membri della Commissione SIO sui farmaci biologici in rinologia.

Riassunto: La rinosinusite cronica con poliposi naso sinusale è una condizione infiammatoria cronica della mucosa naso sinusale, sostenuta prevalentemente da infiammazione di tipo 2 che si associa frequentemente a comorbidità come asma e intolleranza ai FANS. I recenti studi sull’endotyping di malattia hanno rivelato il ruolo cruciale delle citochine dell’infiammazione di tipo 2 nella patogenesi delle forme più severe. L’approccio terapeutico negli ultimi anni si è basato sull’uso di corticosteroidi locali/sistemici e chirurgia endoscopica naso-sinusale. I pazienti con forme più severe, tuttavia, richiedono impiego di alte dosi di corticosteroidi sistemici e ripetuti interventi chirurgici. I dati della letteratura hanno confermato che i nuovi farmaci biologici, specifici per le citochine dell’infiammazione di tipo 2, possono rappresentare un approccio supplementare offrendo un significativo miglioramento clinico nei pazienti affetti da poliposi naso sinusale severa e non controllata. In questo lavoro riportiamo non solo i risultati di una revisione sistematica della letteratura sulle attuali evidenze dei più promettenti farmaci biologici in poliposi naso-sinusale severa non controllata, ma anche i risultati di una consensus su alcuni degli argomenti più dibattuti estratti dai verbali delle riunioni dei membri della Commissione della Società Italiana di Otorinolaringoiatria sui farmaci biologici in rinologia durante il 2020.

Keywords: biologics; chronic rhinosinusitis with nasal polyps; endoscopic sinus surgery; endotyping; type 2 inflammation.

Plain language summary

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory condition of nasal mucosa and paranasal sinuses, predominantly mediated by type 2 inflammation and often associated with comorbid asthma and/or Exacerbated Respiratory Disease (N-ERD). The standard of care involves local and systemic corticosteroids and/or sinonasal surgery, although these options may be associated with recurrences and patients may require revision surgery. Difficult-to-treat patients, in fact, have a more severe disease requiring high systemic corticosteroid use and/or multiple sinonasal surgeries. Literature data suggests that biologic agents targeting specific key effectors of type 2 inflammation may offer supplemental therapy for patients with severe and uncontrolled CRSwNP, leading to significant improvement in several outcomes. For these reasons, over the years the endotyping of the disease has become increasingly important. Herein, we provide not only an update on the existing studies about the most promising biologics in CRSwNP, but also critical discussion on controversies about the use of biologics in severe uncontrolled CRSwNP. We finally provide consensus on strategic issues gathered among experts of the Joint Committee of Italian Society of Otorhinolaryngology on biologics in order to offer the best care for difficult to treat patients.

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References

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