Chronic rhinosinusitis with nasal polyps in adults

CRSwNP usually accompanies those affected throughout their lives. Multiple surgeries and long-term steroid therapy are the standard treatment. This can be extended by biologics use.

Biologics: the new therapy option

Chronic rhinosinusitis with nasal polyps (CRSwNP) usually accompanies sufferers throughout their lives. Multiple operations and long-term steroid therapy are the standard treatment. This can be extended by the use of biologics such as dupilumab and omalizumab to better control the disease.

Immune modulators and cells as targets for biologics

At this year's APACCCI congress, Prof. Dr. C. Bachert (Ghent University Belgium) reported on the important role of cytokines in CRSwNP. Mediators such as interleukin 4 and 5 (IL-4, IL-5) promote inflammation by activating immune cells. These connections can be proven in a large number of those affected with CRS: The so-called inflammatory reaction endotyping in the nasal tissue led to the identification of different subtypes. Most of those affected belong to the type-2 category, which is characterised by an immune response between immunoglobulin E (Ig E), cytokines (IL-4, IL-5) and eosinophils and is associated with the occurrence of nasal polyps and asthma. And it is precisely this patient profile that benefits from the use of the so-called biologics.

Biologically active substances: studies prove efficiency and safety

The addition of biologics to the drug therapy regime can significantly improve the quality of life for patients and reduce the frequency of surgical interventions. These agents, which include dupilumab and omalizumab, interfere with the type 2 immune response and prevent the interaction of cytokines and immune cells. Prof. Dr. Bachert presented several research papers that could confirm this positive effect of the biologically active substances:

The multicentre, randomised, double-blind, placebo-controlled phase 3 SINUS-24 (n = 276) and SINUS-52 (n = 448) trials investigated the efficacy and safety of dupilumab, an IL-4 receptor α inhibitor, compared with placebo in adults with bilateral severe CRSwNP. For 24 and 52 weeks, the following factors were observed: Surgery frequency, symptoms, nasal polyp score, quality of life and cortisone dose level.

Both research studies could show that IL-4 plays an important role in CRSwNP: In the SINUS-24 study, dupilumab improved both the nasal polyp score and the nasal obstruction within 24 weeks. After discontinuation of the medication and observation of the participants until the 48th week, the symptomatology of complaints approached that of the placebo arm.