Biologic treatments for chronic rhinosinusitis

Abstract

Chronic rhinosinusitis is a complex inflammatory disorder manifesting without or with nasal polyps, with the latter being more life-threatening. Current standard care practice includes antibiotics, sinus surgery, and topical and systemic glucocorticosteroids individually or in different combinations. Despite their widespread acceptance, current treatments do not eliminate the reoccurrence of the condition insignificant number of patients. Recently, biologics have proven to be successful for different conditions including asthma. The biologics currently used are immunoglobin-E (IgE) targeting, interleukin (IL) 3,4, and 5 targeting. Omalizumab, Ligelizumab, and M1' antibody are IgE targeting. Omalizumab binds to IgE receptors, while ligelizumab binds to IgE itself and M1 antibody induces apoptosis in B cells, collectively reducing serum IgE. Mepolizumab and Reslizumab are IL-5 targeting biologics working by either binding to free IL-5 or binding to IL-5 receptors, respectively. Pascolizumab and soluble recombinant IL-4 receptors bind to free IL-4. Lastly, lebrikizumab binds to free IL-3 ensuring it doesn't bind to its receptors. Currently, only omalizumab is food and drug administration-approved. Given their success in treating asthma patients and a dire need for effective care plans to help improve the quality of life of patients, this study should serve as a clarion call for the scientific community to study these biologics and introduce standardized treatment plan powered by randomized control trials.