Evaluation of switching or simultaneous use of biologic treatment in patients with severe chronic rhinosinusitis with nasal polyps and severe asthma. Considerations in clinical decision making

ABSTRACT

Introduction

Type 2 targeting biologics have reached the market first for asthma and since 2019 also for CRSwNP. As clear guidelines and predictors for optimal biological choice are missing, patients are sometimes required to switch biologic therapy in order to find the optimal treatment result. In this paper, we evaluate reasons for switching biologics and the treatment effects after each sequential switch.

Materials and methods

Ninety-four patients who switched from one biologic to another for their treatment of CRSwNP and asthma were evaluated.

Results

Twenty patients experienced satisfactory control of CRSwNP, but insufficient control of severe asthma. Fifty-one patients experienced satisfactory control of severe asthma, but insufficient control of CRSwNP/EOM. Twenty-eight patients experienced insufficient control of both upper and lower airways. Thirteen patients had to switch because of side effects. Furthermore, two cases are described to clarify clinical decision-making.

Discussion

For abovementioned patients, a multidisciplinary approach is mandatory to find the best suitable biologic. It seems ineffective to switch to a second anti-IL5 treatment if the first one is not successful. Most patients that failed omalizumab and/or an anti-IL-5 treatment are well controlled on dupilumab. Therefore, we suggest to use dupilumab as first choice when switching biologic agents.

KEYWORDS:

• asthma
• biologics
• CRSwNP
• double treatment
• switching

Article highlights

• Since clear guidelines and predictors for optimal biological choice are missing, patients are sometimes required to switch biologic therapy in order to find the optimal drug for their specific condition

• Evaluation of biological treatment should include upper and lower airways

• Biological treatment of patients with severe CRSwNP and asthma failing to achieve control with the first biological warrants a multi-disciplinary evaluation

• When disease control in both upper- and lower airways cannot be achieved during treatment with a single biologic, treatment with two biologics combined could be considered

• When switching from anti-IL5 treatment to dupilumab, dupilumab can best be started directly after the anti-IL5 treatment to prevent hyper-eosinophilia.

Declaration of interest

R van der Lans has acted as a consultant and/or advisory board member for GSK. W Fokkens is an advisory board member of Sanofi, GSK, and Dianosic. S Reitsma has acted as a consultant and/or advisory board member for Sanofi, GSK, and Novartis. The department of Otorhinolaryngology and Head/Neck Surgery of the Amsterdam UMC has received research funding from Sanofi, GSK, and Novartis. L Klimek has received research grants from Allergy Therapeutics/Bencard, Great Britain/Germany; ALK-Abelló, Denmark; Allergopharma, Germany; ASIT Biotech, Belgium; AstraZeneca, Sweden, Bionorica, Germany; Biomay, Austria, Boehringer Ingelheim, Germany, Circassia, U.S.A; Stallergenes, France; Cytos, Switzerland; Curalogic, Denmark; HAL, Netherlands; Hartington, Spain; Lofarma, Italy; Viatris/Mylan, U.S.A; Novartis, Switzerland, Leti, Spain; ROXALL, Germany; GlaxoSmithKline (GSK), Great Britain; Sanofi, France and/or has served on the speaker’s bureau or was consulting for the above mentioned pharmaceutical companies.

L Klimek is the current President of German Society of Allergology AeDA, Vice-President of the European Academy for Allergy and Clinical Immunology (EAACI), Vice-President of German Academy for Allergy and Environmental Medicine and Editor-in-Chief of AllergoJournal and AllergoJournal International. EDC reports lecture fees and participations in experts board meeting of GSK, Novartis, Sanofi, Astrazeneca. M Bonini has received speaker and advisory board fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmith Kline, Menarini, and Sanofi. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

R van der Lans, J Otten, K Dziadziulia, C Montuori, B Hilvering, E Weersink, M Bonini, J Hagemann, W Thaitrakool, E de Corso, L Klimek, S Reitsma, W Fokkens collected data for the paper. R van der Lans, J Otten, W Thaitrakool, W Fokkens analyzed the data and prepared the tables and figures S Reitsma, L Klimek, E de Corso and W Fokkens designed the analysis All authors reviewed, commented and approved the final manuscript for publication.

Additional information

Funding

This paper was not funded.