Endoscopic Sinus Surgery Superior to Two of Three Biologics in Treating Severe Chronic Rhinosinusitis with Nasal Polyps

How does endoscopic sinus surgery (ESS) with appropriate ongoing medical management compare with biologics use as a treatment for patients with severe nasal polyposis?

BOTTOM LINE:

At 24 and 52 weeks, ESS and dupilumab are comparable; ESS offers some improvements compared to dupilumab, omalizumab, and mepolizumab.

BACKGROUND: Approximately 25% of patients with chronic rhinosinusitis (CRS) suffer from nasal polyposis. Several biologics have demonstrated benefits in measures of CRS disease severity. Although both biologics and ESS are treatment options for patients with severe CRS with nasal polyps (CRSwNP), direct prospective comparative studies between the two do not exist.

STUDY DESIGN: Prospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, S.C.

SYNOPSIS: Study participants diagnosed with severe CRSwNP were enrolled in a multicenter observational cohort study evaluating outcomes following ESS from April 2011 to August 2019. Within the cohort, 111 patients (53% male, mean age 51.9 years) met inclusion criteria. Participants were asked to complete both preoperative and postoperative evaluations. In addition, data from five recently published phase 3 randomized controlled clinical trials investigating use of dupilumab, omalizumab, and mepolizumab in severe CRSwNP were reviewed. Baseline characteristics and outcome measures were compared between these cohorts at 24 weeks and 52 weeks, when possible. At 24 weeks, ESS demonstrated significantly greater improvement in Sino-Nasal Outcome Test (SNOT-22) scores compared to one of two dupilumab trials and both omalizumab trials; at 52 weeks, ESS resulted in statistically similar improvement in SNOT-22 scores compared to dupilumab. At 24 weeks, nasal polyp scores (NPS) in the ESS cohort were significantly lower compared to dupilumab and omalizumab trials; at 52 weeks, NPS were lower in the ESS group than dupilumab and mepolizumab. Study limitations included loss to follow-up for patients in the ESS cohort.

CITATION: Miglani A, Soler ZM, Smith TL, et al. A comparative analysis of endoscopic sinus surgery versus biologics for treatment of chronic rhinosinusitis with nasal polyposis. Int Forum Allergy Rhinol. 2023;13:116–128.