Comparison of the EPOS 2020 and POLINA 2.0 guidelines for indicating biologic treatment in adults with chronic rhinosinusitis and nasal polyps

Abstract

Objective: To analyze the volume of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) to whom biologics would be prescribed based on the European and Spanish clinical practice guidelines, and to evaluate the impact that an increase of 1 required prior surgery (from 1 to 2) may have on the number of indications.

Methods: Cross-sectional analysis evaluating the application of the European Position Paper on CRSwNP Guidelines (EPOS 2020) and the Spanish Consensus on the Management of CRSwNP Guidelines (POLINA 2.0) on an on-going prospective cohort study of consecutive patients with severe CRSwNP in a tertiary hospital.

Results: For a total of 103 patients with severe CRSwNP, 57.3% met EPOS 2020 criteria for biological treatment, whereas only 32% met POLINA 2.0 criteria. However, if the number of surgeries required to prescribe a biological therapy is increased to 2, only 31.1% of the patients would have indication of biological treatment, in any of the two guidelines.

Conclusions: The differences among the POLINA 2.0 and the EPOS 2020 guidelines appear to have an impact in the proportion of patients eligible for biological therapies, with the former being stricter. Increasing the number of prior surgeries required, reduces the proportion of patients eligible for monoclonal antibodies prescription.

Keywords: Biological therapy; Chronic rhinosinusitis with nasal polyps; Directrices; Guidelines; Inflamación de tipo 2; Rinosinusitis crónica con pólipos nasales; Terapia biológica; Type 2 inflammation.