Andrea Rampi1,2, Alessandro Vinciguerra3, Umberto Tanzini1,2, Mario Bussi1,2, Matteo Trimarchi4,5. 1. Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy. 2. School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. 3. Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France. 4. Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy. trimarchi.matteo@hsr.it. 5. School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. trimarchi.matteo@hsr.it.
Abstract
PURPOSE: To compare international and regional guidelines for prescription and monitoring of response to biologics in chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS: A literature review was performed to identify publications reporting indications for biologic therapy in CRSwNP. A full-text reading identified specific issues for comparison: prior surgery, evidence of type 2 inflammation (T2I), smell function, comorbidities, use of systemic corticosteroids, impact on quality of life, and endoscopic and CT findings were compared for the prescription, while the monitoring of the treatment was described in relation to timing, classification of response and criteria for withdrawal. RESULTS: Ten publications were found. Prior surgery was strictly necessary in five guidelines, while in all the remaining it was variably recommended. A confirmation of T2I was considered necessary in one publication, unnecessary in two, and recommended or constituted only one of the factors to consider in seven. All the other issues analyzed were variably considered. Reevaluation was suggested at 4-6 months and 1 year, mostly assessing improvement in the same criteria used for prescription. CONCLUSIONS: A combination of subjective and objective findings is used for the identification of patients with CRSwNP who are indicated for biologic therapy. Major debate has developed on the need for previous surgery, which is generally recommended, or strictly necessary for some authors. Confirmation of T2I is generally suggested, but compulsory only in a minority of guidelines. Smell function, use of systemic corticosteroids, and the impact on quality of life are the other factors most frequently considered.
PURPOSE: To compare international and regional guidelines for prescription and monitoring of response to biologics in chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS: A literature review was performed to identify publications reporting indications for biologic therapy in CRSwNP. A full-text reading identified specific issues for comparison: prior surgery, evidence of type 2 inflammation (T2I), smell function, comorbidities, use of systemic corticosteroids, impact on quality of life, and endoscopic and CT findings were compared for the prescription, while the monitoring of the treatment was described in relation to timing, classification of response and criteria for withdrawal. RESULTS: Ten publications were found. Prior surgery was strictly necessary in five guidelines, while in all the remaining it was variably recommended. A confirmation of T2I was considered necessary in one publication, unnecessary in two, and recommended or constituted only one of the factors to consider in seven. All the other issues analyzed were variably considered. Reevaluation was suggested at 4-6 months and 1 year, mostly assessing improvement in the same criteria used for prescription. CONCLUSIONS: A combination of subjective and objective findings is used for the identification of patients with CRSwNP who are indicated for biologic therapy. Major debate has developed on the need for previous surgery, which is generally recommended, or strictly necessary for some authors. Confirmation of T2I is generally suggested, but compulsory only in a minority of guidelines. Smell function, use of systemic corticosteroids, and the impact on quality of life are the other factors most frequently considered.
Authors: Claus Bachert; Joseph K Han; Martin Desrosiers; Peter W Hellings; Nikhil Amin; Stella E Lee; Joaquim Mullol; Leon S Greos; John V Bosso; Tanya M Laidlaw; Anders U Cervin; Jorge F Maspero; Claire Hopkins; Heidi Olze; G Walter Canonica; Pierluigi Paggiaro; Seong H Cho; Wytske J Fokkens; Shigeharu Fujieda; Mei Zhang; Xin Lu; Chunpeng Fan; Steven Draikiwicz; Siddhesh A Kamat; Asif Khan; Gianluca Pirozzi; Naimish Patel; Neil M H Graham; Marcella Ruddy; Heribert Staudinger; David Weinreich; Neil Stahl; George D Yancopoulos; Leda P Mannent Journal: Lancet Date: 2019-09-19 Impact factor: 79.321
Authors: Catherine A Loftus; Zachary M Soler; Sina Koochakzadeh; Vincent M Desiato; Frederick Yoo; Shaun A Nguyen; Rodney J Schlosser Journal: Int Forum Allergy Rhinol Date: 2019-11-21 Impact factor: 3.858
Authors: Richard R Orlandi; Todd T Kingdom; Timothy L Smith; Benjamin Bleier; Adam DeConde; Amber U Luong; David M Poetker; Zachary Soler; Kevin C Welch; Sarah K Wise; Nithin Adappa; Jeremiah A Alt; Wilma Terezinha Anselmo-Lima; Claus Bachert; Fuad M Baroody; Pete S Batra; Manuel Bernal-Sprekelsen; Daniel Beswick; Neil Bhattacharyya; Rakesh K Chandra; Eugene H Chang; Alexander Chiu; Naweed Chowdhury; Martin J Citardi; Noam A Cohen; David B Conley; John DelGaudio; Martin Desrosiers; Richard Douglas; Jean Anderson Eloy; Wytske J Fokkens; Stacey T Gray; David A Gudis; Daniel L Hamilos; Joseph K Han; Richard Harvey; Peter Hellings; Eric H Holbrook; Claire Hopkins; Peter Hwang; Amin R Javer; Rong-San Jiang; David Kennedy; Robert Kern; Tanya Laidlaw; Devyani Lal; Andrew Lane; Heung-Man Lee; Jivianne T Lee; Joshua M Levy; Sandra Y Lin; Valerie Lund; Kevin C McMains; Ralph Metson; Joaquim Mullol; Robert Naclerio; Gretchen Oakley; Nobuyoshi Otori; James N Palmer; Sanjay R Parikh; Desiderio Passali; Zara Patel; Anju Peters; Carl Philpott; Alkis J Psaltis; Vijay R Ramakrishnan; Murugappan Ramanathan; Hwan-Jung Roh; Luke Rudmik; Raymond Sacks; Rodney J Schlosser; Ahmad R Sedaghat; Brent A Senior; Raj Sindwani; Kristine Smith; Kornkiat Snidvongs; Michael Stewart; Jeffrey D Suh; Bruce K Tan; Justin H Turner; Cornelis M van Drunen; Richard Voegels; De Yun Wang; Bradford A Woodworth; Peter-John Wormald; Erin D Wright; Carol Yan; Luo Zhang; Bing Zhou Journal: Int Forum Allergy Rhinol Date: 2021-03 Impact factor: 5.426