Multi-Disciplinary Expert Perspective on the Management of Type 2 Inflammation-Driven Severe CRSwNP: A Brief Overview of Pathophysiology and Recent Clinical Insights

Abstract

Severe chronic rhinosinusitis with nasal polyposis (CRSwNP) is a disabling airway disease that significantly impacts patients’ lives through the severity of symptoms, the need for long-term medical treatment and the high risk of recurrence post-surgery. Biological agents targeting type 2 immune responses underlying the pathogenesis of CRSwNP have shown effectiveness in reducing polyp size and eosinophilic infiltrate, and in decreasing the need for additional sinus surgeries. However, despite recent progress in understanding and treating the disease, type 2 inflammation-driven severe CRSwNP continues to pose challenges to clinical management due to several factors such as persistent inflammation, polyp recurrence, heterogeneity of disease, and comorbidities. This article presents the findings of a scientific discussion involving a panel of ear, nose and throat (ENT) specialists and pulmonologists across Sweden and Finland. The discussion aimed to explore current management practices for type 2 inflammation-driven severe CRSwNP in the Nordic region. The main topics examined encompassed screening and referral, measurements of disease control, treatment goals, and future perspectives. The experts emphasized the importance of a collaborative approach in the management of this challenging patient population. The discussion also revealed a need to broaden treatment options for patients with type 2 inflammation-driven CRSwNP and comorbid conditions with shared type 2 pathophysiology. In light of the supporting evidence, a shift in the disease model from the presence of polyps to that of type 2 inflammation may be warranted. Overall, this discussion provides valuable insights for the scientific community and can potentially guide the future management of CRSwNP.

Keywords:

• chronic rhinosinusitis
• type 2 immunity
• surgery
• biological therapy
• Nordic countries
• collaboration

Acknowledgments

Medical writing support was provided by Ileana Stoica, PhD, and Carys Ampofo and was funded by Sanofi. All authors were involved in manuscript writing and revision, and gave their final approval for publication.

Disclosure

STS reports consultancies for ALK-Abelló, AstraZeneca, ERT, GSK, Orion Pharma, Novartis, Sanofi, and Roche Products, as well as a grant from GSK, outside the submitted work. LB received speaker or consultant honoraria and/or served on advisory boards during the last three years for: AstraZeneca, Acucort, Birc Pharma, Chiesi, GSK, Phargentis and Sanofi. LOC has participated and received remuneration for advisory boards for GSK and Sanofi. AC reports honorarium from Sanofi for educational activities. TH reports consultancies for ALK-Abello, Astra Zeneca, GSK, Orion, and Sanofi. LL has received payments for consultancy, advisory board participation, lectures or clinical trials from ALK, Astra Zeneca, Boehringer Ingelheim, Chiesi, GSK, Menarini, Novartis, Orion and Sanofi. ML reports consultancies from AstraZeneca, Chordate, finska läkaresällskapet, Finnish ENT society, Sanofi, and Smith & Nephew. JCR has participated in and received remuneration for advisory boards for GSK and Sanofi. SS has received payments for consultancy, advisory board participation, lectures or clinical trials from Viatris, GSK, Orion and Sanofi. The authors report no other conflicts of interest in this work.

Additional information

Funding

This publication was supported by Sanofi. The funder participated in the scientific discussion with the experts.