ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Biologics for Chronic Rhinosinusitis and Nasal Polyposis

by Elizabeth Hofheinz, MPH, MEd • June 9, 2019

  • Tweet
  • Email
Print-Friendly Version

I believe that these new biologics will have an extremely important role in the management of chronic sinusitis with and without NP, but this is a process and we must temper our exuberance. —Timothy L. Smith, MD, MPH

You Might Also Like

  • Are New Biologics a Game Changer for Treating Nasal Polyposis?
  • Do Preoperative Corticosteroids Benefit Patients with Chronic Rhinosinusitis with Nasal Polyposis?
  • What Is the Role of Nasal Endoscopy in the Diagnosis of Chronic Rhinosinusitis?
  • Tips for Treating Chronic Rhinosinusitis with Nasal Irrigation
Explore This Issue
June 2019

Another study endpoint was the sense of smell, which patients rated as more important than congestion. “In our study,” said Dr. Han, “patients whose sense of smell had disappeared were actually able to regain it,  [which is] remarkable and vital to the quality of their lives.”

He thinks biologics will be effective for the management of nasal polyps but added that it’s unclear where within the range of available treatments they will fall.

Bias and Clinical Relevance

Timothy L. Smith, MD, MPH, vice chair of otolaryngology–head and neck surgery and professor of otolaryngology–head and neck surgery in the division of rhinology and sinus/skull base surgery at Oregon Health and Science University in Portland, said he has reservations about biologics.

First, he said, there is the risk of bias assessment. One systematic review looking at the potential for bias in biologics research found “encouraging” results, he said, but added that there there were indeed biases present and a high risk of bias for attrition and reporting, in particular (Rhinology. 2018;56:11–21).

“I sometimes question the clinical relevance of the outcomes in these studies,” Dr. Smith said. He referenced a 2017 randomized, double-blind, placebo-controlled trial that assessed the need for surgery; 105 patients received mepolizumab (n = 54) or placebo (n = 51) (J Allergy Clin Immunol. 2017;140:1024–1031). At the outset, 100% of patients needed surgery; by week 25 the mepolizumab group dropped to 70% and the control dropped to 90%. “That is not statistically significant until you do a post hoc analysis,” he added. “I think it is telling that after six months of expensive therapy, a full 70% [of participants] still needed sinus surgery.”

Regarding the visual analog scale (VAS) scores for NPs, the investigators did find a statistically significant improvement in nasal polyposis severity, but, asked Dr. Smith, “how important to the patient is being at 6.5 versus 5 after six months of expensive, systemic therapy?”

He added that one global issue is that nearly all studies involve some sort of relationship with a pharmaceutical company, with recent larger studies demonstrating multiple potential conflicts of interest.

“Looking back, it seems that we have been down this road before,” said Dr. Smith. “A study published in 2001 looking at montelukast resulted in tremendous hype about using it for NP (J Allergy Clin Immunol. 2001;108:466–467). But reflect on how it figures in our current practice … in my practice it is virtually irrelevant. I believe that these new biologics will have an extremely important role in the management of chronic sinusitis with and without NP, but this is a process and we must temper our exuberance.”

Pages: 1 2 3 4 5 | Single Page

Filed Under: Features, Practice Focus, Rhinology Tagged With: biologic therapies, chronic rhinosinusitus, Nasal polyposis, nasal polyps, Triological Society Annual Meeting 2019Issue: June 2019

You Might Also Like:

  • Are New Biologics a Game Changer for Treating Nasal Polyposis?
  • Do Preoperative Corticosteroids Benefit Patients with Chronic Rhinosinusitis with Nasal Polyposis?
  • What Is the Role of Nasal Endoscopy in the Diagnosis of Chronic Rhinosinusitis?
  • Tips for Treating Chronic Rhinosinusitis with Nasal Irrigation

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Experts Delve into Treatment Options for Laryngopharyngeal Reflux
    • Vertigo in the Elderly: What Does It Mean?
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Is the Training and Cost of a Fellowship Worth It? Here’s What Otolaryngologists Say
    • Vertigo in the Elderly: What Does It Mean?
    • New Developments in the Management of Eustachian Tube Dysfunction
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Eustachian Tuboplasty: A Potential New Option for Chronic Tube Dysfunction and Patulous Disease
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Why Virtual Grand Rounds May Be Here to Stay
    • Otolaryngologist Leverages His Love of Pinball into Second Business
    • These New Imaging Advances May Help to Protect Parathyroids
    • Is the Training and Cost of a Fellowship Worth It? Here’s What Otolaryngologists Say
    • Which Otologic Procedures Poses the Greatest Risk of Aerosol Generation?

Polls

Have you used 3D-printed materials in your otolaryngology practice?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2021 The Triological Society. All Rights Reserved.
ISSN 1559-4939

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.