Management of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in the Pan-Arab Region: Consensus Recommendations from a Multidisciplinary Expert Working Group

Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic and often debilitating inflammatory condition of the nasal and paranasal tissues. An expert panel of specialists from the Gulf region (the Kingdom of Saudi Arabia, Kuwait, Oman and the United Arab Emirates) and from Egypt gathered to evaluate existing guidance and develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the main observations and recommendations from this panel. CRSwNP diagnosis requires the presence of bilateral, endoscopically visualized polyps in the middle meatus (via nasal endoscopy or CT). In most patients, CRSwNP is mediated through predominantly type 2 inflammatory processes and is often observed in patients with asthma and other allergic disease. While many patients respond to medical treatment (principally topical irrigation and intranasal corticosteroids, and adjunctive short-term use of systemic corticosteroids), clinical management of CRSwNP is challenging, and a multidisciplinary approach for complete evaluation and treatment is recommended. Patients with more severe/uncontrolled disease (despite adequate medical therapies) require a complete endoscopic sinus surgery (ESS), although outcomes can be unsatisfactory, and further revision surgery is common. Biological therapies targeting underlying inflammatory processes offer additional, effective treatment options for those patients with persistent symptoms despite complete ESS, and also in those patients where surgery may be contraindicated.

Keywords:

• chronic rhinosinusitis with nasal polyposis
• CRSwNP
• type 2 inflammation
• biologics

Acknowledgments

The authors would like thank Irena Mandic and Stephen McGrath (VMLY&RHealth/IntraMed International) for their support in facilitating the Expert Panel meetings and subsequent activities. Iain O’Neill (independent medical writer) provided support in manuscript development.

Disclosure

RA-A has received honorarium from Sanofi; SA received lecture and advisory board honoraria from Sanofi and GSK; MA-A received lecture and advisory board honoraria from Sanofi, AstraZeneca, and GSK. The authors report no other conflicts of interest in this work.

Additional information

Funding

The logistics of the panel selection, meeting facilitation and subsequent discussions and manuscript development were supported by an unrestricted grant from Sanofi. The sponsor had no influence or involvement in the recommendations developed from the discussions or on the content and viewpoints expressed in this manuscript.