Biologics for chronic rhinosinusitis with nasal polyps.

Abstract

With the increasing recognition of the role of type 2 immune responses in chronic rhinosinusitis, its severity, recurrence, and comorbidities, several biologics targeting IL-4, IL-5, and IL-13 as well as IgE have been administered in small proof-of-concept studies. Recently, the first phase 3 trials have been reported with dupilumab, an IL-4 receptor antagonist, demonstrating a significant and clinically relevant reduction of the disease burden from polyp size and sinus involvement to symptoms and smell; these changes consecutively led to an important increase in quality of life. Finally, the biologic versus placebo treatment reduced the need for systemic glucocorticosteroids and sinus surgery significantly and clinically meaningfully. Dupilumab today is registered for the treatment of chronic rhinosinusitis with nasal polyps in Europe and the United States. Within a year, 2 further phase 3 trials with omalizumab and mepolizumab will be reported. With this development, without any doubt, a new era for the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps has begun. Questions on the indication of the biologics, the selection of patients, and finally criteria for monitoring the efficacy in individual patients need to be urgently answered, and care pathways need to be established integrating the current standard of care including surgery.

• Authors: Claus Bachert, Nan Zhang, Carlo Cavaliere, Wen Weiping, Elien Gevaert, Olga Krysko
• Journal: The Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 145 Issue 3 Pg. 725-739 (03 2020) ISSN: 1097-6825 [Electronic] United States
• PMID: 32145872 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antibodies, Monoclonal, Humanized
• Biological Products
• Omalizumab
• dupilumab
• mepolizumab

Topics

• Antibodies, Monoclonal, Humanized (therapeutic use)
• Biological Products (therapeutic use)
• Chronic Disease
• Humans
• Nasal Polyps (drug therapy, immunology)
• Omalizumab (therapeutic use)
• Rhinitis (drug therapy, immunology)
• Sinusitis (drug therapy, immunology)