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Perspective

Innovative treatments for severe uncontrolled chronic rhinosinusitis with nasal polyps

, &
Pages 837-845 | Received 17 Feb 2023, Accepted 19 Apr 2023, Published online: 24 Apr 2023
 

ABSTRACT

Introduction

In recent years, endotypes of chronic rhinosinusitis (CRS) based on the underlying immune mechanisms provided a better understanding of this heterogeneous disease and are frequently applied in diagnosis and treatment.

Areas covered

In this manuscript, we aim to review novel treatment approaches for this often uncontrolled disease and highlight endotype-driven medical algorithms that could be beneficial in daily clinical practice.

Expert opinion

With the development of endotyping and the mucosal inflammatory concept, several type 2–targeted biologics and surgical options are nowadays available for treating CRS. However, a better understanding based on clinical trials and real-life experience in daily practice is needed to optimize patient selection, biological drug selection, treatment duration, prediction, and long-term follow-up strategies. Indirect comparison analysis suggested that dupilumab might be the most effective biologic for treating CRS with nasal polyps, but the role and timing of surgery remain unclear. More real-life studies and comparative trials are needed for the optimal integration of biologics into clinical pathways in combination with established treatment approaches such as nasal and oral glucocorticosteroids and adequate surgery to provide long-term perspectives.

Article highlights

  • Type 2 inflammation plays an important role in the pathogenesis of CRSwNP.

  • Type 2–targeted biologics and surgical options are available for treating severe uncontrolled CRSwNP.

  • Provide long-term perspectives for disease control with the optimal integration of biologics into clinical pathways in combination with established treatment approaches such as nasal and oral glucocorticosteroids and adequate surgery.

  • Still, more rigorous studies and trials are needed in the future.

Abbreviations

AERD=

Aspirin-exacerbated respiratory disease

BAFF=

B cell-activating factor

CLC=

Charcot-Leyden crystal

CRSsNP=

Chronic rhinosinusitis without nasal polyps

CRSwNP=

Chronic rhinosinusitis with nasal polyps

CSF=

Colony stimulating factor

ECP=

Eosinophil cationic protein

ILC2=

type2 innate lymphoid cells

MBP=

Major basic protein

MMP=

matrix metallopeptidase

NERD=

Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease

NETosis=

Neutrophilic extracellular trap cell death

PAF=

Platelet-activating factor

RANTES=

regulated upon activation, normal T cell expressed and presumably secreted

SA=

Staphylococcus aureus

TIMPs=

tissue inhibition of metalloproteinases

Declaration of interest

C Bachert: Advisory Board member and speaker for Novartis, GSK, Astra-Zeneca, Sanofi, ALK, and Mylan. 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

C. Bachert and N. Zhang contributed to the scientific concept of the review. Y. Huang conceived the article structure, wrote the article, and searched the literature. C. Bachert and N. Zhang critically revised the manuscript. All these authors read and approved the final manuscript for publication.

Additional information

Funding

This review was supported by the Chinese Postdoctoral Science Foundation (2022M723611)

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