Surgery is a time-honored treatment with low side effects. If a patient’s symptoms come back, then I would consider biologics. Biologics give us another piece in our armamentarium of treatment. —James N. Palmer, MD
Explore This Issue
November 2019
Shared Decision Making
Will otolaryngologists feel threatened by the emergence of biologics that reduce the number of sinus surgeries? This is a natural response, “but also a completely inappropriate way for us to respond to new treatments and technologies that may benefit our patients,” says Dr. Smith. “We have a potential conflict of interest as sinus surgeons. Our allergy/immunology colleagues have a potential conflict of interest as well. The worst thing we can do is put our patients in the middle of our conflicts of interest.”
Dr. Laidlaw, an allergist, said she works in a multidisciplinary manner with surgeons in her health system, so patients are referred to the right clinician for treatment appropriate for their situation.
Dr. Smith agreed. “This highlights the need for multidisciplinary management of this patient population. None of us has all the tools. We need to work together,” he said. “This issue really pushes the paradigm of multidisciplinary collaboration, and that’s where we should take this, almost like tumor boards in cancer treatment. We can make recommendations to patients as a multidisciplinary group.”
Susan Bernstein is a freelance medical writer based in Georgia.
Key Points
- Biologics target and suppress specific drivers of inflammation and work well in some patients to treat the symptoms of nasal polyps.
- Cost and the need for regular injections for an indefinite period of time are two major concerns among otolaryngologists.
Biologics: Inflammatory Targets
Biologics suppress inflammation, so the argument in favor of these drugs is that they will be more effective in patients with poorly controlled, severe nasal asthma and polyps that are inflammation-driven, but there are still many unknowns about these drugs in this patient population, said Dr. Bleier.
“If you have a patient who is struggling with asthma control, has severe polyps, and is a poor surgery candidate, they may be a good biologics candidate. We always have to balance the cost of therapy and the true efficacy of therapy,” he said. “Because these drugs are very new, in addition to unknown efficacy across the general spectrum of patients, we don’t know if there will be a rebound effect, or if there is better efficacy in treatment-refractory patients.”
Dr. Bleier describes polyps as “bags full of inflammatory products,” or cytokines that are targeted by biologics. Once polyps are surgically removed, he wonders if biologics may work better, because “the cytokines are already reduced.”