Biologics Shown Effective in Real-World Setting for Managing Patients with Severe Chronic Rhinosinusitis with Nasal Polyps

by Linda Kossof •

CLINICAL QUESTION

How do the clinical effects and response times of dupilumab, omalizumab, and mepolizumab compare when treating patients with severe, uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP)?

BOTTOM LINE

Dupilumab, omalizumab, and mepolizumab significantly improve quality of life and reduce nasal polyp size in patients with CRSwNP, with dupilumab showing the fastest response.

BACKGROUND: Recent advances have led to a classification of CRS based on immunopathological profiles. Biologic agents targeting type 2 inflammation, the most common form of CRSwNP in Western populations, have demonstrated efficacy in the treatment of severe, uncontrolled CRSwNP. Selecting appropriate patients, biologics, and timing is crucial to providing personalized, cost-effective care, however.

STUDY DESIGN: Retrospective study

SETTING: ENT Department, SS. Annunziata Hospital, Cosenza, Italy

SYNOPSIS: Researchers studied 33 patients (18 men; mean age 44.69 years) with severe uncontrolled CRSwNP treated between April and December 2023. Patients self-administered one of three biologics: dupilumab (n=14), omalizumab (n=11), or mepolizumab (n=8). Outcomes were assessed by SNOT-22 for quality of life, nasal polyp score (NPS) for polyp size, and Sniffin’ Sticks-12 for olfactory function, comparing differences from baseline to four weeks, three, six, and nine months. Another primary objective was to investigate whether monoclonal antibodies could improve olfactory functions. All three groups showed similarly significant improvements in SNOT-22 scores from baseline to nine months. Overall, 57.6% and 81% of patients had a good/excellent response at six and nine months, respectively. Dupilumab showed the most rapid improvement in NPS from four weeks onward, whereas omalizumab and mepolizumab showed significant NPS reductions by six months. The dupilumab group showed a notable decrease in anosmic patients (64.3% to 28.6% at nine months). Asthma control improved across all groups. The absence of allergic rhinitis was strongly associated with a reduced likelihood of control at six months, indicating that the shared underlying immune pathway of type 2 inflammation contributes to both conditions. Study limitations included its retrospective nature.

CITATION: De Santis S, et al. Clinical effects and response time of biological drugs in chronic rhinosinusitis with nasal polyps patients: real-life experience. Laryngoscope. 2024. doi: 10.1002/lary.31948.