Therapy For Chronic Rhinosinusitis Research Articles

Pädiatrische Rhinologie.

The following review article highlights key topics in pediatric rhinology that are currently the focus in research and at conferences as well as in the interdisciplinary discussion between otorhinolaryngologists and pediatricians. In particular, congenital malformations such as choanal atresia or nasal dermoid cysts are discussed, followed by statements on the current procedures for sinogenic orbital complications as well as on the diagnosis and therapy of chronic rhinosinusitis in children. Furthermore, updates on the role of the ENT specialist in the care for children with cystic fibrosis and primary ciliary dyskinesia are provided.

Expression of serotonergic (5HT) receptors in patients with chronic rhinosinusitis with nasal polyposis and in normal nasal mucosa

Expression of serotonergic (5HT) receptors in patients with chronic rhinosinusitis with nasal polyposis and in normal nasal mucosa: a case-control study.Background Chronic rhinosinusitis with nasal polyposis is one of the challenging conditions regarding treatment and management. Many recent studies introduced new modalities for treatment like targeted immunomodulating drugs rather than antihistamines, local and systemic steroids, and endoscopic sinus surgery. Understanding the pathology behind the disease by studying its immunologic pathways and substances that take part in the inflammatory process can help in the introduction of new treatment options that can improve outcomes and decrease the costs of treatment.Objective The aim of our study is to demonstrate the presence of 5-HT receptors in nasal polyps and inferior turbinate mucosa in patients with chronic rhinosinusitis with nasal polyposis and then compare this expression of 5-HT receptors with inferior turbinate mucosa of the normal control group.Methods A case-control study was conducted on 80 patients. Specimens from nasal polypi and turbinate mucosa of patients with chronic rhinosinusitis (cases) and specimens from normal turbinate mucosa (controls) were stained with serotonin receptor Immunohistochemical staining by automated immunostainer in the pathology department laboratory in Ain Shams University Hospital with ratio 1:200–400 as recommended by the manufacturing company. Then, compared as regards stain distribution and intensity of mucosal lining, glands, and blood vessels.Results There was a significant difference between polyp cases and controls as regards lining epithelium and mucosal gland stain distribution and stain intensity. Also significant difference between the polyp cases and controls as regards blood vessel strain distribution. However, no significant difference was found as regards blood vessel stain intensity. There was a significant difference between turbinate cases and controls as regards lining epithelium stain distribution, and stain intensity. There was no significant difference between turbinate cases and controls as regards gland stain distribution. However, a significant difference was found between turbinate and controls as regards gland stain intensity. There was a significant difference between turbinate cases and controls as regards blood vessel stain distribution; however, no significant difference was present as regards stain intensity. There was no significant difference between polyp and turbinate cases as regards lining epithelium and blood vessel stain distribution and stain intensity. There was no significant difference between polyp and turbinate cases as regards gland stain distribution; however, a highly significant difference between polyp and turbinate cases as regards gland stain intensity.Conclusion Serotonin receptors are highly expressed in patients with chronic rhinosinusitis with nasal polyposis in both turbinate and polypoidal tissues which proves that serotonin has a strong role in the formation and growth of nasal polypi and allergic reactions. Hence serotonin modulating drugs can be studied as a new therapy for chronic rhinosinusitis with nasal polyposis.

A systematic review of randomised controlled trials on topical nasal steroids.

Intranasal corticosteroids (INCs) are the first line of therapy for chronic sinonasal conditions such as rhinitis and rhinosinusitis. Among these, one of the most frequently used is beclomethasone dipropionate (BDP). Over the years many studies have evaluated the efficacy of BDP as part of therapy for chronic rhinosinusitis (CRS) and allergic rhinitis (AR) along with nasal washes, which seems to be very well tolerated. To analyse the data in the literature regarding the various therapeutic regimens of BDP in different sinonasal disease and their efficacy and tolerability. Using different search engines, the posology, efficacy, and tolerability of BDP were reviewed and a total of 64 full-length articles were examined for eligibility. After applying inclusion and exclusion criteria, 4 articles were reviewed. BDP is among the group of INCs with significant improvement of nasal symptoms and has good efficacy and safety. BDP nasal spray is one of the most frequently prescribed INC for rhinitis and rhinosinusitis. Treatment with BDP resulted in significant and clinically meaningful improvements in nasal symptoms associated with AR and CRS. BDP is well tolerated, and the safety profile is similar to that of placebo in most patients. These results, in conjunction with the significant benefit reported in subjects with CRS and AR, provide convincing evidence of the overall effectiveness of BDP for the treatment of the full spectrum of sinonasal disease.

The Inflation Reduction Act: Implications for Medicare spending and access to biologic therapies for chronic rhinosinusitis with nasal polyposis and asthma.

In 2021, Medicare spending on biologics was $926million in Part B (FFS) and $1.3 billion in Part D (FFS/MA). Between 2017 and 2021, annual Medicare spending on biologics increased by approximately 200%. Between 2023 and 2025, Medicare Part D OOP costs for biologics will decrease by an estimated 50%-60%.

Dual and triple modulator therapy for chronic rhinosinusitis in cystic fibrosis patients.

The introduction of CFTR modulators has changed the landscape in the treatment of cystic fibrosis (CF) and early case series have shown improvements in sinonasal outcomes in this patient population. A real-word data study was performed to evaluate the impact of dual therapy with tezacaftor/ivacaftor (TEZ/IVA) and triple therapy with elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) on CF-related chronic rhinosinusitis (CRS), by comparing subjective and objective outcome measures at baseline, 12 months after treatment with TEZ/IVA and six months after treatment with ELX/TEZ/IVA. In total, 43 CF patients, with a mean age of 32 years, were included. After triple therapy, significant improvements in overall visual analogue scale, SNOT-22, Lund Kennedy, nasal polyps, and Lund-Mackay scores were observed, whereas no beneficial effect could be seen in patients treated with dual therapy. Bacterial upper airway colonization did not differ pre- and postmodulator therapy in the present study. The number of responders to dual and triple therapy is 23.8% and 63.2% of the patients, respectively. Triple therapy with ELX/TEZ/IVA is superior to dual therapy with TEZ/IVA in the treatment of CF-CRS, as significantly reduced sinonasal complaints, nasal endoscopy and CT scores were observed after triple therapy, whereas this was not the case for dual therapy.

Updated epithelial barrier dysfunction in chronic rhinosinusitis: Targeting pathophysiology and treatment response of tight junctions.

Tight junction (TJ) proteins establish a physical barrier between epithelial cells, playing a crucial role in maintaining tissue homeostasis by safeguarding host tissues against pathogens, allergens, antigens, irritants, etc. Recently, an increasing number of studies have demonstrated that abnormal expression of TJs plays an essential role in the development and progression of inflammatory airway diseases, including chronic obstructive pulmonary disease, asthma, allergic rhinitis, and chronic rhinosinusitis (CRS) with or without nasal polyps. Among them, CRS with nasal polyps is a prevalent chronic inflammatory disease that affects the nasal cavity and paranasal sinuses, leading to a poor prognosis and significantly impacting patients' quality of life. Its pathogenesis primarily involves dysfunction of the nasal epithelial barrier, impaired mucociliary clearance, disordered immune response, and excessive tissue remodeling. Numerous studies have elucidated the pivotal role of TJs in both the pathogenesis and response to traditional therapies in CRS. We therefore to review and discuss potential factors contributing to impair and repair of TJs in the nasal epithelium based on their structure, function, and formation process.

Impact of dupilumab prescribing on utilization of medical and surgical therapies for chronic rhinosinusitis with nasal polyps.

Increased dupilumab utilization coincided with decreased ESS in patients with CRSwNP between 2019 and 2021. One potential confounder was the concurrent COVID-19 pandemic, which may have negatively impacted surgery utilization rates.

Omalizumab Treatment in Uncontrolled Asthma and CRSwNP Patients, with Previous Endoscopic Sinus Surgery, to Improve Quality of Life and Endoscopic Outcomes: a Two-Year Real-Life Study.

Despite molecular underlying advances, limited and divergent data on monoclonal antibodies (mAb)therapy in chronic rhinosinusitis with nasal polyps (CRSwNP) make further analysis necessary. The objective of this study is to evaluate the effect of omalizumab as an adjunct to endoscopic sinus surgery (ESS) on the treatment of CRSwNP under real-life conditions. Since the introduction of omalizumab, as the first biologic agent for the treatment of diseases such as severe allergic asthma, different studies have demonstrated an effect of omalizumab on CRSwNP, with significant improvements in sinonasal symptoms and endoscopic scores. The high efficacy derived from mAb therapy and the need for ESS prior to mAb recommended by guidelines, has led to compare both therapeutic alternatives, finding discrepancies in their effect on quality of life (QoL) and complementary tests outcomes. Patients with moderate-to-severe asthma with clinical criteria for omalizumab indication, and coexistent CRSwNP disease, were selected for a non-randomized interventional retrospective study into four treatment subgroups.Measures were analyzed and compared between groups and over time at the baseline, 16weeks and 1 and 2years after treatment. Omalizumab treatment in patients with previous ESS exhibited an earlier and more pronounced improvement in QoL, symptoms scale and endoscopic findings (nasal polyp score and the bilateral modified Lund-Kennedy) as early from week 16, which improvement persisted for 2years. A greater mean improvement of 33.4 ± 6.5 (95% CI: 20.3-46.4; p < 0.001) points in sinonasal outcome test 22 (SNOT-22) was associated with ESS at week 16, against omalizumab effect (17.8 ± 7.6 [95% CI: 2.6-33.0]; p = 0.023). At year 2, an improvement in SNOT-22 of 62.6 ± 8.9 (95% CI: 48.4-84.1; p < 0.001) points was exclusively associated with omalizumab. Clinical evidence of the effect of omalizumab added to ESS treatment is provided in this study in the short- and long-term.

Comparative short-term efficacy of endoscopic sinus surgery and biological therapies in chronic rhinosinusitis with nasal polyps: A network meta-analysis.

To compare the safety and efficacy between endoscopic sinus surgery and different biologics in treating chronic rhinosinusitis with nasal polyps in adults by reviewing the existing clinical trials. Data extraction and risk of bias assessment were conducted by 2 independent reviewers according to the PRISMA recommendations and any disagreement was resolved by a third investigator. Outcomes were measured through a random-effects model. We searched Embase, Web of Science, MEDLINE, Cochrane, and other relevant sources from its inception to April 30, 2022. We included randomized controlled trials(RCTs) involving endoscopic sinus surgery (ESS) or biologics in treating adult patients with chronic rhinosinusitis with nasal polyps. Studies involving other miscellaneous diseases, non-RCT design, and insufficient participants or follow-up were excluded. In this systematic review, five RCTs and 1748 patients were included. All the biologics, as well as ESS, could significantly improve key nasal outcomes in CRSwNP both at 6months and 1year. Dupilumab exhibited better efficacy than ESS in improving SNOT-22 scores at one year. However, ESS showed superiority over three biologics in improving nasal congestion scores (NCS) at two various time points, except for better efficacy of Dupilumab at 1year. For the loss of smell scores, a greater improvement was observed in the Dupilumab cohort compared with other biologics and even ESS counterparts. Safety analysis showed no significant difference between the ESS cohort and biologic treatment. In summary, ESS showed comparable improvement in quality of life and symptoms to Omalizumab, Mepolizumab, and Benralizumab. Dupilumab seems to be more effective than ESS in selected items, whereas head-to-head trials and real-world studies are urgent to compare their efficacy. Our findings also showed that biologics could be applied as alternative or adjuvant therapy for uncontrolled severe CRSwNP.

Advances in biologic therapies for chronic rhinosinusitis with nasal polyps

Chronic rhinosinusitis (CRS) is a complex multifactorial inflammatory disease that affects more than ten percent of the adult population globally. CRS represents a large healthcare burden and is associated with significant morbidity. Despite conventional medical and surgical treatments, a subset of patients continue to have poor symptom control due to substantial inflammatory disease persistence. These difficult-to-treat patients represent ideal candidates for biologic therapeutics, which target key inflammatory processes implicated in CRS disease. Biologic agents targeting type 2 inflammation have been shown to reduce disease burden. Phase 3 clinical trials studying the effects of anti-IgE, anti-IL-5/anti-IL-5Rα, and anti-IL-4/IL-13 humanized monoclonal antibodies have shown the efficacy of these therapies to reduce polyp size, the need for revision surgeries, improve daily symptoms, and downregulate inflammatory markers while maintaining an acceptable safety profile. The reductions seen in inflammatory mediators are largely transient following treatment termination and additional investigations are required to discern the long-term effects of biologic use on disease modulation. Specifically, the evidence suggests that these biologics are beneficial for patients with CRSwNPs with comorbid asthma and aspirin exacerbated respiratory disease (AERDBiologics should be used sparingly because of significant cost and accessibility of the treatment. Current guidelines recommend that biologics be reserved for patients with CRSwNP with moderate to severe disease who have failed conventional medical and surgical therapy. Further studies are needed to better endotype patients to optimize biologic use, evaluate long-term effectiveness and compare the relative effectiveness of biologic therapies in these difficult-to-treat patients.

The Mechanism of Action and Clinical Efficacy of Low-Dose Long-Term Macrolide Therapy in Chronic Rhinosinusitis.

Various chronic inflammatory airway diseases can be treated with low-dose, long-term (LDLT) macrolide therapy. LDLT macrolides can be one of the therapeutic options for chronic rhinosinusitis (CRS) due to their immunomodulatory and anti-inflammatory actions. Currently, various immunomodulatory mechanisms of the LDLT macrolide treatment have been reported, as well as their antimicrobial properties. Several mechanisms have already been identified in CRS, including reduced cytokines such as interleukin (IL)-8, IL-6, IL-1β, tumor necrosis factor-α, transforming growth factor-β, inhibition of neutrophil recruitment, decreased mucus secretion, and increased mucociliary transport. Although some evidence of effectiveness for CRS has been published, the efficacy of this therapy has been inconsistent across clinical studies. LDLT macrolides are generally believed to act on the non-type 2 inflammatory endotype of CRS. However, the effectiveness of LDLT macrolide treatment in CRS is still controversial. Here, we reviewed the immunological mechanisms related to CRS in LDLT macrolide therapy and the treatment effects according to the clinical situation of CRS.

Dupilumab in complex therapy for chronic rhinosinusitis with nasal polyps and asthma

Chronic Rhinosinusitis with Nasal Polyps (CRwNP) caused by T2 inflammation has a complex pathogenesis, for which treatment options include medical therapy (topical and systemic glucocorticosteroids, leuktriene inhibitors, etc.) and surgical therapy, often recurs and significantly reduces the quality of life for patients. Chronic rhinosinusitis with nasal polyps is common in patients with asthma and, particularly, severe asthma and an allergic reaction to nonsteroidal anti-inflammatory drugs. These conditions are in most cases associated with a common pathogenesis, including a type II immune response, hyperproduction of interleukins (IL) 4, 5 and 13, activation of eosinophils and tissue remodeling. Biological therapy which block the effect of IL-4, 5, 13 can significantly improve the condition of such patients. Dupilumab is a humanized IgG4 monoclonal antibody that targets the IL-4 receptor alpha chain (IL-4Rα), thereby blocking the action of IL-4 and IL-13. Currently, dupilumab is approved for asthma, CRwNP and atopic dermatitis. Dupilumab can reduce the number of exacerbations, treatment with systemic corticosteroids, improve the condition of the upper and lower respiratory tract and achieve an increase in FEV1 by 0.2–0.3 L, which leads to a significant control of these diseases. One of the topical issues is the choice of tactics choice of treatment tactics in patients with CRwNP, asthma and nasal septum deviation. This article presents a clinical case of a patient with severe asthma, CRwNP and deviated nasal septum receiving dupilumab for 4 months.

Clinical outcomes of dupilumab therapy in chronic rhinosinusitis with nasal polyps in a Canadian tertiary care rhinology practice

BackgroundIn 2020, dupilumab became the first monoclonal antibody therapy to be approved by Health Canada for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). The primary aim of this study was to characterize the outcomes in an initial cohort of patients with CRSwNP who have undergone dupilumab therapy.MethodsA retrospective study was conducted of patients with CRSwNP who were treated with dupilumab. Demographic information, comorbidities, number of previous surgeries, and insurance information were collected. The primary outcome were changes in the sinonasal outcome test (SNOT-22) scores from baseline to timepoints after receiving dupilumab.ResultsForty-eight patients were considered for dupilumab therapy, and 27 (56%) received coverage or were able to fund the medication independently. Patients waited an average of 3.6 months to obtain access to the medication. The mean age of the patients was 43. Forty-one percent (11/27) of patients had aspirin exacerbated respiratory disease, and 96% (26/27) had a diagnosis of asthma. The mean length of time on dupilumab was 12.1 months. The baseline SNOT-22 score was 60.6. The mean decrease at 1 month, 3 months, 6 months, and 12 months after starting dupilumab was 8.8, 26.5, 42.8, and 33.8, respectively. There were no serious adverse events.ConclusionPatients treated with dupilumab in a Canadian tertiary care rhinology clinic demonstrated substantial clinical improvement as measured by disease-specific sinonasal outcomes. Further studies are needed to determine the longer-term effectiveness and adverse event profile of this novel therapy.

Nasal washes in chronic rhinosinusitis, review article

Chronic rhinosinusitis (CRS) is a chronic condition of inflammation in the mucosa of the paranasal sinuses that is associated with a significantly impaired quality of life, which motivates the constant study of therapies for its control and cost reduction. The cutting edge of clinical management for CRS is topical therapy. The advantages of topical medical therapy include direct administration of the drug into the diseased tissue, the possibility of administering higher local concentrations of the drug and minimizing systemic absorption which is not without adverse effects, thus becoming an important strategy in the management of CRS. The objective of this literature review is to formally review and identify topical medical therapy strategies and promote an evidence-based approach to their use. A literature review was conducted based on a keyword search. The computerized databases of PubMed, ElSevier and ResearchGate were accessed. We included articles highlighting the results of the use of topical therapies in CRS and that the type of study was a clinical trial. This review identified and evaluated the literature on topical therapy strategies for CRS: saline irrigation, topical antibiotics, topical steroids, and topical antifungals. Topical therapy has become an important tool in the treatment arsenal for CRS. Based on a review of the literature, nasal irrigation with saline and topical steroid sprays are the most evidence supportive. Nonstandard topical nasosinusal steroid therapies may be an option for managing CRS.

Nasal washes in chronic rhinosinusitis, review article

Chronic rhinosinusitis (CRS) is a chronic condition of inflammation in the mucosa of the paranasal sinuses that is associated with a significantly impaired quality of life, which motivates the constant study of therapies for its control and cost reduction. The cutting edge of clinical management for CRS is topical therapy. The advantages of topical medical therapy include direct administration of the drug into the diseased tissue, the possibility of administering higher local concentrations of the drug and minimizing systemic absorption which is not without adverse effects, thus becoming an important strategy in the management of CRS. The objective of this literature review is to formally review and identify topical medical therapy strategies and promote an evidence-based approach to their use. A literature review was conducted based on a keyword search. The computerized databases of PubMed, ElSevier and ResearchGate were accessed. We included articles highlighting the results of the use of topical therapies in CRS and that the type of study was a clinical trial. This review identified and evaluated the literature on topical therapy strategies for CRS: saline irrigation, topical antibiotics, topical steroids, and topical antifungals. Topical therapy has become an important tool in the treatment arsenal for CRS. Based on a review of the literature, nasal irrigation with saline and topical steroid sprays are the most evidence supportive. Nonstandard topical nasosinusal steroid therapies may be an option for managing CRS.

Olfaction Now and in the Future in CRSwNP.

Chronic rhinosinusitis (CRS) is the leading cause of olfactory dysfunction in the general population. Olfactory dysfunction is more common in patients with CRS with nasal polyposis (CRSwNP) compared to those without polyps. The present review aims to summarize the current literature on the mechanism behind olfactory dysfunction in CRSwNP and the impact of therapy on olfactory outcomes in this patient population. A comprehensive review of the available literature on olfaction in CRSwNP was performed. We evaluated the most recent evidence from studies on the mechanisms behind smell loss in CRSwNP and the impact of medical and surgical therapy for CRS on olfactory outcomes. The mechanism behind olfactory dysfunction in CRSwNP is not completely understood, but evidence from clinical research and animal models suggests both an obstructive component causing conductive olfactory loss and an inflammatory response in the olfactory cleft leading to sensorineural olfactory loss. Oral steroids and endoscopic sinus surgery have both shown efficacy in improving olfactory outcomes in CRSwNP in the short term; however, the long-term response of these treatments remains uncertain. Newer targeted biologic therapies, such as dupilumab, have also shown remarkable and durable improvement in smell loss for CRSwNP patients. Olfactory dysfunction is highly prevalent in the CRSwNP population. Although significant advances have been made in our understanding of olfactory dysfunction in the setting of CRS, additional studies are needed to elucidate cellular and molecular changes mediated by type 2-mediated inflammation in the olfactory epithelium with potential downstream effects on the central olfactory system. Further identification of these underlying basic mechanisms will be vital for developing future therapies targeted to improve olfactory dysfunction in patients with CRSwNP.

IL-17A facilitates type 2 inflammation in a modified eosinophilic chronic rhinosinusitis mouse model.

Eosinophilic chronic rhinosinusitis (ECRS) is predominantly characterized by nasal type 2 inflammation. The pathogenesis of this condition is complex. High levels of IL-17A are associated with eosinophil infiltration in some inflammatory diseases and contribute to the severity and insensitivity of corticosteroid therapy for chronic rhinosinusitis. In the first experiment, we constructed a modified ECRS mouse model using four groups of mice: phosphate-buffered saline (PBS)-sensitized and nasal instillation (control); PBS-sensitized and Staphylococcus aureus enterotoxin B (SEB) nasal instillation after nasal tamponade (SEB group); ovalbumin (OVA)-sensitized and nasal instillation (OVA group); and OVA-sensitized combined with OVA and SEB nasal instillation after nasal tamponade (OVA+SEB group). In the second experiment, we examined the role of IL-17A by dividing the mice into four groups: control group; ECRS group; ECRS+anti-IL-17A group; and ECRS + IL-17A group. The latter two groups received intraperitoneal injections of anti-IL-17A antibody or IL-17A, respectively. We constructed a modified ECRS mouse model (OVA+SEB group), where the IL-17A levels were upregulated in the nasal sinus of ECRS mice and the IL-17A levels were significantly correlated with eosinophil infiltration. We further demonstrated that IL-17A induced type 2 inflammation and eosinophil infiltration in the ECRS group of mice. In contrast, IL-17A neutralization attenuated type 2 inflammatory cytokine secretion and eosinophil infiltration. OVA sensitization and unilateral nasal tamponade, combined with SEB and OVA alternate nasal instillation (OVA+SEB group), could be used to construct a more typical ECRS mouse model in which IL-17A enhanced the expression of type 2 cytokines and eosinophil infiltration.

Topical Administration of Verapamil in Poly(ethylene glycol)-Modified Liposomes for Enhanced Sinonasal Tissue Residence in Chronic Rhinosinusitis: Ex Vivo and In Vivo Evaluations.

Verapamil is a calcium channel blocker that holds promise for the therapy of chronic rhinosinusitis (CRS) with and without nasal polyps. The verapamil-induced side effects limit its tolerated dose via the oral route, underscoring the usefulness of localized intranasal administration. However, the challenge to intranasal administration is mucociliary clearance, which diminishes localized dose availability. To overcome this challenge, verapamil was loaded into a mucoadhesive cationic poly(ethylene glycol)-modified (PEGylated) liposomal carrier. Organotypic nasal explants were exposed to verapamil liposomes under flow conditions to mimic mucociliary clearance. The liposomes resulted in significantly higher tissue residence compared with the free verapamil control. These findings were further confirmed in vivo in C57BL/6 mice following intranasal administration. Liposomes significantly increased the accumulation of verapamil in nasal tissues compared with the control group. The developed tissue-retentive verapamil liposomal formulation is considered a promising intranasal delivery system for CRS therapy.

INFLUENCE OF AMINOCAPRONIC ACID ON THE REGRESSION OF NASAL POLYPS AND NASAL CONGESTION IN PATIENTS WITH POLYPOUS RHINOSINUSITIS

Chronic rhinosinusitis with nasal polyposis (CRS with NP) is a clinical syndrome including several clinical phenotypes and endotypes with differences in pathophysiology and is divided into neutrophilic (non-type 2) and eosinophilic (type 2) according to the dominant endotype, which is the most severe variant associated with therapy resistance and frequent recurrence. Such pheno-endotype requires personalized treatment, and pharmacotherapy based on endotyping is prospective. Aminocapronic acid (ACA) competitively inhibits plasminogen and plasmin formation, inhibits C3a and C5a, which can affect the pathophysiological mechanisms of eosinophilic inflammation and polypous growth, since, in addition to hemostatic properties, it also has desensitizing, anti-enzymatic, and anti-proliferative properties.&#x0D; The aim of the research: to evaluate the influence of additional administration of aminocapronic acid on the degree of regression of nasal polyps in comparison with patients receiving standard therapy of Chronic rhinosinusitis with nasal polyposis according to clinical recommendations.&#x0D; Material and methods. The study included 120 outpatients, divided into two groups: the main (n - 60) and control (n - 60) ones. The average age of the main group was 45.8 years; the control group was 47.0 years. Patients were prescribed basic treatment (irrigation therapy with saline solutions and mometasone furoate), and in the main group – additionally aminocapronic acid (ACA). The evaluation of treatment effectiveness was based on the analysis of the dynamics of nasal congestion and the regression of nasal polyps at V2 (day 5±1), V3 (day 10±1), V4 (day 20±1) and V5 (day 30±1) compared to V0. Indications for surgical treatment were determined at V3.&#x0D; Results. The use of aminocapronic acid in Chronic rhinosinusitis with nasal polyposis contributes to a reliable reduction in the severity of the main clinical symptoms (rhinorrhea, postnasal drip, nasal congestion, reduced sense of smell), nasal congestion starting from V2, regression of polyps – from V3 compared to patients of the control group. This ensured a statistically significant 25% reduction in the number of operated patients: 56.7% in the main group versus 81.7% in the control (p&lt;0.05). Conservative treatment was continued by 43.3% of patients of the main group and by 18.3% of patients of the control group (p&lt;0.05). After the operated patients were removed from the groups, they did not significantly differ in the dynamics of regression of nasal congestion and nasal polyps at V4 and V5 (p&gt;0.05). Differences in the results of treatment are attributed to the clinical effects of Aminocapronic acid (ACA), since the group characteristics of the patients were commensurable.&#x0D; Conclusions:&#x0D; &#x0D; the additional appointment of Aminocapronic acid (ACA) to patients with Chronic rhinosinusitis with nasal polyposis contributes to a faster regression of nasal congestion associated with edematous changes of the mucous membrane of the nasal cavity, compared to the regression of polyps during the fifth day of treatment;&#x0D; there is a significant difference in the severity of symptoms in the main group during the 10th day of treatment compared to patients in the control group;&#x0D; the reliable positive dynamics of clinical symptoms correlates with a reliable, at 25%, decrease in the number of operative interventions in the main group.&#x0D;

Efficacy and safety of monoclonal antibody therapy for chronic rhinosinusitis with nasal polyposis

Abstract Chronic rhinosinusitis (CRS) is one of the most common chronic inflammatory syndromes reported in the general population, with high prevalence reported. It is classified in two distinct entities depending on the endotype dominance, either type 2 or non-type 2, – chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps. CRSwNP is described as a type 2 inflammatory disease, with the implication of T-helper 2 inflammation mechanisms with a secondary increase in the concentration of eosinophils and total Immunoglobulin E. CRSwNP is characterized by a high recurrence rate even after endoscopic sinus surgery. Considering the challenges associated with the treatment of CRSwNP, new medical therapies, such as monoclonal antibodies, have been developed over the years. Biologics with anti-IL-5, anti-IgE, anti-IL-4 receptor alpha (IL-4-Rα) action have been developed and tested for the treatment of asthma, eosinophilic dermatitis, and secondarily evaluated and approved for the treatment of chronic rhinosinusitis with nasal polyps. In this review, we make a synthesis of the monoclonal antibodies available and their efficacy and safety in the treatment of nasal polyposis.