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Treatment options for chronic rhinosinusitis with nasal polyps
Allergy and Asthma Proceedings
|December 6, 2021
Summary
Updated guidelines for chronic rhinosinusitis with nasal polyps (CRSwNP) emphasize treating type 2 inflammation. Biologics like dupilumab are recommended for severe CRSwNP, but a comprehensive treatment algorithm is still needed.
Area of Science:
- Otolaryngology
- Allergy and Immunology
- Pharmacology
Background:
- Chronic rhinosinusitis with nasal polyps (CRSwNP) management is shifting towards addressing underlying type 2 inflammation.
- Current treatment strategies are evolving to incorporate new evidence and therapeutic options.
Purpose of the Study:
- To synthesize updated evidence-based recommendations for medical and surgical management of CRSwNP.
- To clarify the role of biologic therapies within the CRSwNP treatment algorithm.
Main Methods:
- Comparative review of European and International consensus guidelines (EPOS 2020, ICAR 2021).
- Analysis of therapeutic recommendations for CRSwNP, including corticosteroids, biologics, and other agents.
Main Results:
- Intranasal corticosteroids are strongly recommended; oral corticosteroids for short-term use. Biologics like dupilumab are indicated for severe CRSwNP meeting specific criteria.
- Aspirin desensitization may benefit patients with AERD. Antifungals, antileukotrienes, antihistamines, and decongestants have limited or no proven benefit.
- Surgery is beneficial, but criteria for failure of maximal medical therapy are undefined. Guidelines for initiating/discontinuing biologics are lacking.
Conclusions:
- An evidence-based algorithm is needed to guide surgical intervention and biologic therapy initiation/discontinuation in CRSwNP.
- Optimizing CRSwNP management requires clear guidelines for maximizing quality of life and cost-effectiveness.
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