COMMENT: AFRS can be a challenging condition to treat with recurrence. Treatment typically relies on well-performed endoscopic sinus surgery, removal of fungal elements and inspissated secretions, and the delivery of topical corticosteroids in high-volume irrigations, often with the need for oral corticosteroids in cases of recurrence. The approval data for biologic medications specifically excluded these patients; however, this meta-analysis finds that in patients with refractory AFRS, biologics can provide significant benefit in those who have failed routine medical therapy. These medications may offer an additional option for these patients, who traditionally needed to have repeated courses of oral corticosteroids and/or revision surgeries for management of their disease.—Ashoke Khanwalkar, MD.
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