Burden of Disease in Chronic Rhinosinusitis with Nasal Polyps

Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammation-mediated disease of the nasal mucosa and paranasal sinuses with an under-recognized clinical, humanistic, and economic burden. Patients with CRSwNP experience a high symptom burden, including nasal congestion, loss of smell, and rhinorrhea, which has a negative impact on physical and mental health-related quality of life, including sleep quality. Existing medical and surgical interventions, including local and systemic corticosteroids and endoscopic sinus surgery, may be associated with recurrence of nasal polyps and associated symptoms and with an increased risk of short- and long-term adverse effects, especially with repeated or long-term use. Because type 2 inflammation is implicated in the pathogenesis of several coexisting diseases, patients with CRSwNP often have comorbid asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease. These patients, as well as those with high corticosteroid use and/or sinonasal surgical history, have more severe disease and associated symptom burden and represent a difficult-to-treat population under the existing management paradigm. This article reviews the clinical, humanistic, and economic burden of CRSwNP; it highlights the unmet need for effective and safe CRSwNP therapies that effectively control symptoms and minimize recurrence by targeting the underlying type 2 inflammatory disease pathophysiology.

Keywords:

• disease severity
• healthcare economics
• paranasal sinus disease
• quality of life

Abbreviations

COPD, chronic obstructive pulmonary disease; CRS, chronic rhinosinusitis; CRSwNP, chronic rhinosinusitis with nasal polyps; CT, computed tomography; HRQoL, health-related quality of life; IgE, immunoglobulin E; IL, interleukin; NSAID-ERD, nonsteroidal anti-inflammatory drug-exacerbated respiratory disease; SCS, systemic corticosteroid; SF-36, Short-Form Health Survey questionnaire.

Acknowledgments

We thank Siddhesh Kamat, of Regeneron Pharmaceuticals, Inc., for his contributions to the manuscript. Medical writing/editorial assistance was provided by Maggie Tarrio Watson, PhD, of Excerpta Medica, funded by Sanofi Genzyme and Regeneron Pharmaceuticals, Inc.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, agreed on the journal to which the article was submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Professor Claus Bachert reports personal fees from and Principal Investigator of study and advisory board for GSK, Principal Investigator of study for AstraZeneca and Sanofi, consulting for Mylan, consulting and presentations for ALK, outside the submitted work; and is an advisory board member of ALK, AstraZeneca, GlaxoSmithKline, Intrexon Actobiotics, Novartis, Sanofi, and Stallergenes Greer.

Dr Neil Bhattacharyya reports personal fees from Sanofi, outside the submitted work and is a consultant for Sanofi.

Dr Martin Desrosiers reports personal fees from GlaxoSmithKline, grants from Sanofi and Regeneron, advisory board, speaker bureau, and clinical investigator for GlaxoSmithKline, Sanofi and Regeneron, and AstraZeneca, during the conduct of the study; is a major equity holder of Probionase Therapies outside the submitted work; has received clinical trial funding from AstraZeneca, GlaxoSmithKline, Probionase Therapies, and Sanofi; and is an advisory board member of Regeneron Pharmaceuticals, Inc. and Sanofi.

Dr Asif H Khan reports being an employee of Sanofi, during the conduct of the study and may hold stock and/or stock options.

Additional information

Funding

This work was supported by Sanofi and Regeneron Pharmaceuticals, Inc.