EUFOREA consensus on biologics for CRSwNP with or without asthma

Area of Science:

• Respiratory Medicine
• Immunology
• Pharmacology

Background:

• Chronic inflammatory respiratory diseases like asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) often exhibit type 2 inflammation.
• Type 2 inflammation is prevalent in CRSwNP and asthma, affecting sinonasal mucosa and/or lungs.
• These conditions frequently coexist, suggesting systemic therapies could benefit both upper and lower airways.

Framework:

• Type 2-targeting biologics (e.g., anti-IgE, anti-IL4Rα, anti-IL5, anti-IL5Rα) are approved for specific asthma phenotypes.
• These biologics are anticipated for CRSwNP treatment, addressing unmet needs in severe disease.
• A multidisciplinary expert meeting convened to discuss the integration of biologics into CRSwNP care pathways, considering comorbid asthma.

Implementation:

• Biologics offer a new treatment modality for patients with severe, uncontrolled type 2 inflammatory respiratory diseases.
• Systemic biological therapy can potentially alleviate pathology in both the upper (sinonasal) and lower (lung) airways.
• The high cost and prevalence necessitate careful patient selection for optimal use of these novel therapies.

Implications:

• Strategic implementation of biologics requires defining patient phenotypes and endotypes for targeted therapy.
• Careful patient selection is paramount for maximizing therapeutic benefit and managing healthcare costs.
• Integrating biologics into care pathways can improve outcomes for patients with complex, comorbid respiratory conditions.