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The role of biologics in chronic rhinosinusitis: a systematic review
Author(s) -
Iqbal Isma Z.,
Kao Stephen ShihTeng,
Ooi Eng Hooi
Publication year - 2020
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22473
Subject(s) - medicine , mepolizumab , nasal polyps , omalizumab , dupilumab , asthma , nonallergic rhinitis , placebo , adverse effect , benralizumab , eosinophilia , quality of life (healthcare) , randomized controlled trial , dermatology , immunology , immunoglobulin e , eosinophil , antibody , pathology , alternative medicine , nursing
Background Chronic rhinosinusitis (CRS) refractory to medical and surgical treatment is challenging. It impacts patients’ quality of life significantly. The pathophysiology of CRS has some similarities to allergic asthma and allergic rhinitis (AR) and includes eosinophilia, T‐helper cell 2 cytokines, and local immunoglobilin E formation. Monoclonal antibody therapy has been used successfully in asthma and AR and more recently in CRS. Our was aim to systematically review the literature and identify the role of monoclonal antibodies (MAbs) in the treatment of CRS with polyps (CRSwNP) and without polyps (CRSsNP), especially with regard to comparability with current medical treatment, efficacy, and risk of complications. In addition, the role of surgery and biologics was evaluated. Methods We identified at total of 5341 relevant studies after a comprehensive database search. Six studies met the inclusion criteria, all 6 randomized, controlled trials. Results Treatment with omalizumab and mepolizumab demonstrated improvements in endoscopic nasal polyp score (EPS) and symptoms score in patients with CRSwNP when compared with placebo. Reslizumab reduced nasal polyp size in patients with raised intranasal interleukin‐5 levels. Dupilumab treatment resulted in a 70% reduction in EPS compared with 20% in the placebo group ( p < 0.001). These MAbs target different inflammatory markers involved in the pathophysiology of CRSwNP. None of the studies reported on CRSsNP or combined surgery with biologics. No severe adverse events were reported. Conclusion Evidence demonstrates that use of MAbs leads to clinical improvement in CRSwNP. However, further research is required to determine their long‐term effects, comparability to other medical treatments, and potential side effects.