Canadian Rhinologists More Comfortable with Prescribing and Managing Biologics for CRSwNP than Non-Rhinologists 

by Linda Kossoff •

CLINICAL QUESTION

What can be learned from otolaryngologists’ experiences in prescribing biologics for patients with chronic rhinosinusitis with nasal polyposis (CRSwNP), including prescribing practices, patient factors guiding prescriber decisions, and physician and patient-reported issues?

BOTTOM LINE

Rhinologists appear more knowledgeable and willing to prescribe biologics for CRSwNP compared with other otolaryngologists; all prescribers should become familiar with guidelines, indications, and potential adverse events associated with these medications.

BACKGROUND: Chronic rhinosinusitis is driven by varied inflammatory processes that result in a spectrum of clinical presentations, outcomes, and responses. Data support the use of biologics, which target type 2 inflammation, to improve signs and symptoms of CRSwNP. As the use of biologics increases, understanding prescribing practices and barriers early becomes more important.

STUDY DESIGN: Survey study

SETTING: Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada

SYNOPSIS: Researchers developed a 21-item questionnaire regarding otolaryngologists’ experiences with biologics and sent it to members of the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS), who work within a healthcare system that does not include prescription drugs. Responses were tabulated for the cohort and compared between rhinologists and non-rhinologists where appropriate. Of 182 active members, 79 (62 males), completed the survey. Most had been in clinical practice for fewer than five years (39%) and practiced in a community setting (62%). Most (42%) practiced general otolaryngology, followed by rhinology (28%). More rhinologists than non-rhinologists reported prescribing biologic medications on their own (100% versus 50%). In rank order, the most prescribed biologics were dupilumab, mepolizumab, and omalizumab. Rhinologists were more likely to consider poor response to therapies, need for steroids, and comorbid type 2 conditions in their decision to pursue biologics than non-rhinologists; however, rhinologists also experienced poorer assistance from patient support programs and reduced availability of medications. A significantly higher proportion of non-rhinologists than rhinologists reported a lack of familiarity with side effects and how to manage them as limiting factors. The most frequently reported barrier to prescribing biologics was cost. Study limitations included confining the survey to CSOHNS members.

CITATION: Bell CM, Thamboo AV, Monteiro E, et al. Prescribing practices and barriers of biologics for chronic rhinosinusitis amongst otolaryngologists. Laryngoscope [published online ahead of print February 27, 2024]. doi: 10.1002/lary.31370.