Biologics for Nasal Polyps: Why, When and Which One? (2022 AMW)
2022 AAO-HNSF Annual Meeting & OTO Experience
The recent approval of several biologic therapy has opened up a new paradigm of treatment for recalcitrant chronic rhinosinusitis with nasal polyposis (CRSwNP). This includes conditions such as allergic fungal rhinosinusitis, eosinophilic granulomatosis with polyangiitis and aspirin exacerbated respiratory disease. Biologic agents can be very effective in some patients, but not all patients. Many patients with recurrent nasal polyposis have severe biologically recalcitrant disease, whereas in others inadequate surgery may contribute to early recurrence of nasal polyps. The duration of therapy with biologic agent, long-term adverse effects and total costs are currently not understood. Given these considerations, diligence must be exercised in selecting patients for biologic therapy versus “standard of care” (surgery and conventional maintenance medical therapy). While patients with severe biological recalcitrance may be optimally served by the use of a biologic, other patients may be well or better served by standard of care utilizing meticulous revision surgery and postoperative maintenance medical therapy. Multidisciplinary management of these patients with an allergy-immunologist is optimal. This panel of seasoned Otolaryngology and Allergy Immunology experts will discuss optimal use of biological therapy for CRSwNP. We will outline how to identify which patients are best suited for potential biological therapy. Considerations in selection of the “right” biologic through interpretation of postoperative sinus CT, serum assays and histopathology, lower airway and immunologic testing will be discussed.
Credits
CME:1.0, MOC:1.0