Although evidence is often mixed, the expanding realm of biologics is becoming a resource that’s increasingly tapped to treat pediatric disease, physician experts said at the 2022 Triological Society Combined Sections Meeting. They discussed biologic therapy options for chronic rhinosinusitis with polyps, neurofibromatosis type 2, and recurrent respiratory papillomatosis.
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June 2022Chronic Rhinosinusitis
There are no biologic therapies approved yet for chronic rhinosinusitis (CRS) in children, but they are on the way, said Amber Luong, MD, PhD, a professor of otorhinolaryngology at the University of Texas at Austin.
Three biologic agents—dupilumab, omalizumab, and mepolizumab are all approved for chronic rhinosinusitis with polyps in adults, but they’re also approved for treating children for other conditions, such as asthma. Two others—reslizumab and benralizumab—have either completed a clinical study or are near completion in adults and could be approved for use in pediatric patients within the next year, Dr. Luong said.
In adults, polyp scores tend to fall after treatment with a biologic begins but rise again when treatment is suspended. This poses a question that will probably face the pediatric population as well once biologics become more widely available in pediatrics: How long should patients be treated with biologics? “They’re not curative, so the question of how long to keep a patient on biologics isn’t known,” Dr. Luong said.
There’s only a very small group of patients that had early onset chronic rhinosinusitis and then consistently had persistent sinus inflammations, even into adulthood. So, it’s a very small group of patients who may be at risk of recurrent disease and needing something like a biologic. —Amber Luong, MD, PhD
In a longitudinal birth cohort study involving 1,246 kids with a 40-year follow-up, researchers found that the prevalence of physician-diagnosed sinusitis was 10.8% (83 of 772) at age 6. By age 32, most patients had never developed sinusitis or experienced transient sinusitis with the prevalence of adult chronic sinusitis, at 14.6% (J Allergy Clin Immunol. 2018;141:1291-1297).
“There’s only a very small group of patients—about 3.4%—that had early onset chronic rhinosinusitis and then consistently had persistent sinus inflammations, even into adulthood,” said Dr. Luong. “So, it’s a very small group of patients that we’re talking about who may be at risk of recurrent disease and needing something like a biologic.”
Allergic Fungal Rhinosinusitis
Allergic fungal rhinosinusitis tends to require revision surgery more frequently than other CRS types, so the only pediatric clinical trial (currently ongoing) for a biologic—dupilumab—targets the condition, Dr. Luong said.