Current and future treatment options for adult chronic rhinosinusitis: Focus on nasal polyposis

• Published in: Journal of allergy and clinical immunology Vol. 136; no. 6; pp. 1431 - 1440
• Main Authors: Bachert, Claus, MD, PhD, Zhang, Luo, MD, Gevaert, Phillippe, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2015; Elsevier Limited
• Subjects: Accreditation; Adult; Allergies; Allergy and Immunology; Antibodies, Monoclonal, Humanized - therapeutic use; Aspirin - adverse effects; Asthma - epidemiology; Chronic rhinosinusitis; Comorbidity; Copyright; Cytokines; Disease; DNA, Catalytic - therapeutic use; Drug Hypersensitivity - epidemiology; Endoscopy; GATA-3; GATA3 Transcription Factor - immunology; gene silencing; humanized and fully human mAbs; Humans; IgE; IL-13; IL-4; IL-5; Lactococcus lactis - genetics; Medical research; Medicin och hälsovetenskap; nasal polyps; Nasal Polyps - drug therapy; Nasal Polyps - epidemiology; Nasal Polyps - immunology; Nasal Polyps - surgery; Organisms, Genetically Modified; Patients; Quality of life; Rhinitis - drug therapy; Rhinitis - epidemiology; Rhinitis - immunology; Rhinitis - surgery; Sinusitis - drug therapy; Sinusitis - epidemiology; Sinusitis - immunology; Sinusitis - surgery; Surgery; TH2; United States > US; Chronic rhinosinusitis; CRS; IgE; Aspirin-exacerbated respiratory disease; AERD; CRSwNP; GATA-3; CRSsNP; Humanized mAb; T H2; Allergic fungal rhinosinusitis; Computed tomography; nasal polyps; Glucocorticosteroid; Endoscopic sinus surgery; ESS; IL-4; gene silencing; IL-5; IL-13; CT; Chronic rhinosinusitis without nasal polyps; Chronic rhinosinusitis with nasal polyps; humanized and fully human mAbs; GCS; hmAb; AFRS; TH2; T(H)2
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2015.10.010

Chronic rhinosinusitis (CRS) affects more than 10% of the population in the United States and Europe. Recent findings point to a considerable variation of inflammatory subtypes in patients with CRS with nasal polyps and patients with CRS without nasal polyps. According to current guidelines, glucocorticosteroids and antibiotics are the principle pharmacotherapeutic approaches; however, they fail in a group of patients who share common clinical and laboratory markers. Several clinical phenotypes often leading to uncontrolled disease, including adult nasal polyposis, aspirin-exacerbated respiratory disease, and allergic fungal rhinosinusitis, are characterized by a common endotype: a TH 2 bias is associated with a higher likelihood of comorbid asthma and recurrence after surgical treatment. As a consequence, several innovative approaches targeting the TH 2 bias with humanized mAbs have been subjected to proof-of-concept studies in patients with CRS with nasal polyps with or without comorbid asthma: omalizumab, reslizumab, mepolizumab, and recently dupilumab. Future concepts using upstream targets, such as GATA-3, also focus on this endotype. This current development might result in advantages in the treatment of patients with the most severe CRS.