Clinical Remission in Chronic Rhinosinusitis With Nasal Polyps: a Delphi Consensus from the Rhinosinusitis Italian...

Area of Science:

• Otolaryngology
• Immunology
• Clinical Therapeutics

Background:

• Clinical remission in chronic rhinosinusitis with nasal polyps (CRSwNP) is increasingly important with biologic therapies.
• Current CRSwNP remission definitions are inconsistent, hindering study comparability and clinical application.
• Standardized criteria are needed to establish remission as a treatment target.

Purpose of the Study:

• To establish a multidisciplinary, evidence-based definition for clinical remission in CRSwNP.
• To integrate symptom, endoscopic, therapeutic, and timing criteria for remission assessment.
• To evaluate expert consensus on a composite remission score for CRSwNP.

Main Methods:

• A three-round Delphi consensus process involving experts from the Rhinosinusitis Italian Network (RINET).
• Experts rated statements on a 5-point Likert scale to achieve ≥70% agreement or disagreement for consensus.
• Descriptive statistics were used to analyze response convergence and stability.

Main Results:

• Consensus was reached on remission criteria across four domains: timing (≥12 months), no systemic corticosteroids/surgery, symptom thresholds (SNOT-22 <20, VAS ≤ 3), and endoscopic scores (NPS/mLRS 0 for complete, ≤2 for partial).
• Complete and partial remission, sustained remission (≥24 months), and a weighted composite remission score were agreed upon.
• The consensus provides distinct criteria for complete and partial remission in CRSwNP.

Conclusions:

• The study presents the first operational, multidomain definition of complete and partial clinical remission in CRSwNP.
• Developed by a multidisciplinary panel with patient input, the criteria offer a practical framework for standardized assessment.
• The proposed definition supports the adoption of remission as a therapeutic goal in CRSwNP management.