Patients with severe CRSwNP represent an unmet clinical need in terms of recurrent disease despite current medical and surgical therapy. Targeting type 2 inflammatory cytokines (IL4/5/13) appears to be a promising therapeutic approach for such patients akin to what has already been seen in severe asthma. An indirect comparison from Phase 3 placebo controlled trials have shown relative improvements in the co-primary end point of nasal polyp score ranging from a 15% reduction (-0.8 units) with mepolizumab, 18% with omalizumab (-1.14 units) and a 35% (-2.06 units) with dupilumab. This trend was mirrored by relative improvements in health status with the SNOT-22 score showing a 21% reduction (-13.7 units) with mepolizumab, 27% (-16.1 units) with omalizumab, and 43% (-21.1 units) with dupilumab, all exceeding the MCID of 8.9 units . All biologics improved the co-primary end point of nasal airway blockage and also reduced the need for rescue medical/surgical polypectomy. We advocate performing real life studies looking at the response to biologics in patients who are at increased risk for disease recurrence, including initial optimal medical and surgical polyp clearance prior to commencing biologics.
Copyright © 2021. Published by Elsevier Inc.

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