Multidisciplinary Decision-Making-ITAlian Consensus After Two Years of Real Practice on the Management of Severe Uncontrolled CRSwNP by Biologics (ITACA Study)

Eugenio De Corso¹, Carlotta Pipolo², Marco Caminati³, Elena Cantone⁴, Veronica Seccia⁵, Lorenzo Cecchi⁶, Eustachio Nettis⁷, Massimiliano Garzaro⁸, Giancarlo Ottaviano⁹, Matteo Gelardi¹⁰, Carlo Cavaliere¹¹, Enrico Heffler^{12

13}, Fabio Pagella^{14

15}, Ernesto Pasquini¹⁶, Matteo Trimarchi¹⁷, Stefania Gallo¹⁸, Ignazio La Mantia¹⁹, Sara Torretta²⁰, Davide Mattavelli²¹, Cristiano Caruso²², Andrea Matucci²³, Alessandra Vultaggio²³, Gianluca Bellocchi²⁴, Matteo Alicandri Ciufelli²⁵, Passali Fm²⁶, Gianenrico Senna³

Affiliations

¹ Otolaryngology, Head and Neck Surgery, Rhinology, A. Gemelli University Hospital Foundation, IRCSS, Rome, Italy. eugenio.decorso@policlinicogemelli.it.
² Department of Health Sciences, Otolaryngology Unit, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy.
³ Department of Medicine, Allergy Unit and Asthma Center, University of Verona, Verona University Hospital, Verona, Italy.
⁴ Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, Italy. Head and Neck Department-ENT Section, University of Naples, AOU Federico II, 29 Federico II, 80131, Naples, Italy.
⁵ Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
⁶ SOSD Allergology and Clinical Immunology, Ospedale S. Stefano, USL Toscana Centro, Prato, Italy.
⁷ Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy.
⁸ Department of Otorhinolaryngology, Rhinology Unit, Eastern Piedmont University - Maggiore Hospital, Novara, Italy.
⁹ Department of Neurosciences, Otolaryngology Section, University of Padova, Padua, Italy.
¹⁰ Unit of Otolaryngology, University of Foggia, Foggia, Italy.
¹¹ Department of Sense Organs, Sapienza University of Rome, Rome, Italy.
¹² Personalized Medicine Asthma and Allergy Unit - IRCCS Humanitas Research Hospital, Milan, Italy.
¹³ Department of Biomedical Sciences, Humanitas University, Milan, Italy.
¹⁴ Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
¹⁵ IRCCS Policlinico San Matteo, Pavia, Italy.
¹⁶ Otorhinolaryngology Unit, Ospedale Bellaria Dip Chirurgie Specialistiche AUSL BO, Bologna, Italy.
¹⁷ Department of Otolaryngology-Head and Neck Surgery, Ente Ospedaliero Cantonale, Ospedale Regionale Di Lugano, Università Della Svizzera Italiana, Lugano, Svizzera, Italy.
¹⁸ Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, Otorinolaryngology Unit, University of Insubria, Varese, Italy.
¹⁹ Department of Medical - Surgical Sciences and Advanced Technologies-G.F. Ingrassia Director of E.N.T. Unit, P.O.G. Rodolico University of Catania, Catania, Italy.
²⁰ Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
²¹ Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili Brescia, University of Brescia, 25123, Brescia, Italy.
²² Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
²³ Immunoallergoly Unit, Careggi University Hospital, Florence-Largo Brambilla, 3-50134, Florence, Italy.
²⁴ Department of Otolaryngology, San Camillo Forlanini Hospital, Rome, Italy.
²⁵ Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy.
²⁶ Unit of ENT, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy.

PMID: 38472601
DOI: 10.1007/s11882-024-01135-z

Review

Multidisciplinary Decision-Making-ITAlian Consensus After Two Years of Real Practice on the Management of Severe Uncontrolled CRSwNP by Biologics (ITACA Study)

Eugenio De Corso et al. Curr Allergy Asthma Rep. 2024 Mar.

. 2024 Mar;24(3):143-154.

doi: 10.1007/s11882-024-01135-z. Epub 2024 Mar 12.

Authors

Affiliations

¹ Otolaryngology, Head and Neck Surgery, Rhinology, A. Gemelli University Hospital Foundation, IRCSS, Rome, Italy. eugenio.decorso@policlinicogemelli.it.
² Department of Health Sciences, Otolaryngology Unit, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy.
³ Department of Medicine, Allergy Unit and Asthma Center, University of Verona, Verona University Hospital, Verona, Italy.
⁴ Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, Italy. Head and Neck Department-ENT Section, University of Naples, AOU Federico II, 29 Federico II, 80131, Naples, Italy.
⁵ Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
⁶ SOSD Allergology and Clinical Immunology, Ospedale S. Stefano, USL Toscana Centro, Prato, Italy.
⁷ Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy.
⁸ Department of Otorhinolaryngology, Rhinology Unit, Eastern Piedmont University - Maggiore Hospital, Novara, Italy.
⁹ Department of Neurosciences, Otolaryngology Section, University of Padova, Padua, Italy.
¹⁰ Unit of Otolaryngology, University of Foggia, Foggia, Italy.
¹¹ Department of Sense Organs, Sapienza University of Rome, Rome, Italy.
¹² Personalized Medicine Asthma and Allergy Unit - IRCCS Humanitas Research Hospital, Milan, Italy.
¹³ Department of Biomedical Sciences, Humanitas University, Milan, Italy.
¹⁴ Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
¹⁵ IRCCS Policlinico San Matteo, Pavia, Italy.
¹⁶ Otorhinolaryngology Unit, Ospedale Bellaria Dip Chirurgie Specialistiche AUSL BO, Bologna, Italy.
¹⁷ Department of Otolaryngology-Head and Neck Surgery, Ente Ospedaliero Cantonale, Ospedale Regionale Di Lugano, Università Della Svizzera Italiana, Lugano, Svizzera, Italy.
¹⁸ Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, Otorinolaryngology Unit, University of Insubria, Varese, Italy.
¹⁹ Department of Medical - Surgical Sciences and Advanced Technologies-G.F. Ingrassia Director of E.N.T. Unit, P.O.G. Rodolico University of Catania, Catania, Italy.
²⁰ Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
²¹ Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili Brescia, University of Brescia, 25123, Brescia, Italy.
²² Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
²³ Immunoallergoly Unit, Careggi University Hospital, Florence-Largo Brambilla, 3-50134, Florence, Italy.
²⁴ Department of Otolaryngology, San Camillo Forlanini Hospital, Rome, Italy.
²⁵ Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy.
²⁶ Unit of ENT, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy.

PMID: 38472601
DOI: 10.1007/s11882-024-01135-z

Abstract

Purpose of review: We aimed to reach an Italian multidisciplinary consensus on some crucial aspects of treatment decision making in CRSwNP, following 2 years of clinical experience in order to support specialists in the management of CRSwNP in clinical practice. We addressed issues relating to therapeutic decision-making and shared criteria for the treatment choice, as well as appropriate timing and criteria for evaluating treatment response, and highlighted the need for repeated multidisciplinary assessments.

Recent findings: A national survey has been conducted recently to understand how rhinology practice has changed in Italy with the advent of biologics and how this affects patients with uncontrolled, severe CRSwNP. Despite the many published consensus documents, practical recommendations, and protocols on the use of biologics in CRSwNP, heterogenous behaviors in practice are still observed mainly conditioned by the novelty of the topic. The consensus procedure followed a modified Delphi approach. The scientific board included 18 otorhinolaryngologists and 8 allergists, who selected the 4 main topics to be addressed and developed overall 20 statements. Consensus on these statements was sought by a larger group of 48 additional experts, through two rounds of voting, the first web-based, the second in presence with discussion and possible refinement of the statements. The statements reaching an average score ≥ 7 at the second voting round were approved. Five statements were proposed for each of the following topics: baseline evaluation of patients eligible for biologic therapy; choice between different therapeutic options; assessment of the response to biologic treatment; multidisciplinary management. At the first voting round, 19 out of the 20 statements reached a mean score ≥ 7. Following the discussion and a few consequent amendments, at the second round of voting all the 20 statements were approved.

Keywords: Biological therapy; Chronic rhinosinusitis with nasal polyps; Dupilumab; Mepolizumab; Multidisciplinary management; Omalizumab; Response assessment; Type 2 inflammation.

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References

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Multidisciplinary Decision-Making-ITAlian Consensus After Two Years of Real Practice on the Management of Severe Uncontrolled CRSwNP by Biologics (ITACA Study)

Affiliations

Multidisciplinary Decision-Making-ITAlian Consensus After Two Years of Real Practice on the Management of Severe Uncontrolled CRSwNP by Biologics (ITACA Study)

Authors

Affiliations

Abstract

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

Publication types

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LinkOut - more resources

Full Text Sources