Abstract
Novel therapies such as type 2 targeting biologics are emerging treatment options for patients with chronic inflammatory respiratory diseases, fulfilling the needs of severely uncontrolled patients. The majority of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and over half of patients with asthma show a type 2 inflammatory signature in sinonasal mucosa and/or lungs. Importantly, both chronic respiratory diseases are frequent comorbidities, ensuring alleviation of both upper and lower airway pathology by systemic biological therapy. Type 2‐targeting biologics such as anti‐IgE, anti‐IL4Rα, anti‐IL5, and anti‐IL5Rα have entered the market for selected pheno/endotypes of asthma patients and may soon also become available for CRSwNP patients. Given the high prevalence of chronic respiratory diseases and the high cost associated with biologics, patient selection is crucial in order to implement such therapies into chronic respiratory disease care pathways.The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) organized a multidisciplinary Expert Board Meeting to discuss the positioning of biologics into the care pathways for CRSwNP patients with and without comorbid asthma.
Highlights
The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) defines Chronic rhinosinusitis (CRS) clinically based on symptoms supported by signs of mucosal inflammation found on imaging or with nasal endoscopy.[5]
Given that biologics come with a high cost for the healthcare system, careful selection of patients is highly recommended
The EUFOREA expert team has put forward five criteria that are important in the decision to prescribe biologics in chronic rhinosinusitis with nasal polyps (CRSwNP) with prior sinus surgery (Figure 1): Evidence of type 2 inflammation Need for systemic corticosteroids in the past 2 years Significant quality‐of‐life impairment Significant loss of smell Diagnosis of comorbid asthma
Summary
Chronic rhinosinusitis (CRS) is a chronic inflammatory condition of the sinonasal cavities that affects 5%‐12% of the general population worldwide according to epidemiological studies.[1,2,3,4] The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) defines CRS clinically based on symptoms supported by signs of mucosal inflammation found on imaging or with nasal endoscopy.[5]. The EUFOREA expert team has put forward five criteria that are important in the decision to prescribe biologics in CRSwNP with prior sinus surgery (Figure 1): Evidence of type 2 inflammation (biological biomarker) Need for systemic corticosteroids in the past 2 years Significant quality‐of‐life impairment Significant loss of smell Diagnosis of comorbid asthma. The following criteria were agreed by the expert team to define response to biological therapy after 1 year (Figure 2): Reduced nasal polyp size Reduced need for systemic corticosteroids Improved quality of life Improved sense of smell Reduced impact of comorbidities. Recommendations of the Board included the development of a multidisciplinary integrated care pathway and subsequent implementation in daily practice with systematic evaluation of both upper and lower airways at every visit; treatment adjustments with attention to the full unified airways; regular measurement of type 2 biomarkers; and monitoring of the use of systemic corticosteroids
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