Clinical efficacy and mechanisms of biologics for chronic rhinosinusitis with nasal polyps
Abstract
The management of chronic rhinosinusitis with nasal polyps (CRSwNP) can be challenging, particularly when standard treatments including intranasal corticosteroids and endoscopic sinus surgery do not achieve adequate control of symptoms. CRSwNP is frequently characterized by a type 2 immune signature and many patients have other co-morbid type 2 conditions including asthma. There are currently three biologic therapies approved for the treatment of CRSwNP—omalizumab, mepolizumab, and dupilumab—and there are promising therapies in development. Biologic therapies allow for improved patient quality of life in CRSwNP, reduction in need for systemic corticosteroid treatment and endoscopic sinus surgery, and improvement in treatment of co-morbidities. Translational studies assessing how biologic therapies can modify inflammation in CRSwNP have allowed for a greater understanding of CRSwNP pathogenesis. Herein we will review CRSwNP clinical trial and real-world data on the effectiveness and safety of biologics, discuss their therapeutic mechanisms, assess outcomes of biologic therapy versus endoscopic sinus surgery, and discuss therapies in development and future directions.
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