Is there a future for biologics in the management of chronic rhinosinusitis?

Kent Lam, Robert C. Kern, Amber Luong*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

22 Scopus citations

Abstract

Background: Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory condition of the sinonasal mucosa consisting of poorly defined subtypes and characterized by variable clinical manifestations, responses to therapy, and underlying pathophysiologies. In the related disorder of asthma, progress has been made in defining disease subtypes on both clinical and pathophysiologic levels, facilitating the development of targeted biologic pharmacotherapy. The potential role of these drugs for the management of CRS will be reviewed. The objective of this work is to highlight the emerging therapeutic targets in CRS in light of evolving treatment options for asthma and enhanced understandings of the clinical manifestations and pathophysiology of CRS. Methods: This article is a review of recent studies regarding current and future advances in biomarker-directed therapies in the medical treatment of CRS. Results: Various biologic therapies used in the management of asthma have demonstrated clinical promise for CRS, particularly within the CRS with nasal polyposis (CRSwNP) phenotype. Several randomized, double-blind, placebo-controlled studies increasingly support the targeting of immunoglobulin E (IgE) and interleukin (IL)-5 pathways to improve outcome measures in CRSwNP patients. The IL-4/IL-13 pathway and other type 2 inflammatory pathways have also shown potential as targets for CRSwNP, but all pathways require further investigation. Conclusion: Recalcitrant CRS in the United States and Europe is most commonly associated with nasal polyposis and a type 2 cytokine skewing in the tissue, resulting in tissue infiltration of eosinophils, mast cells, and basophils. Targeting biomarkers of the associated type 2 pathways may be a practical treatment option for recalcitrant CRSwNP in the future.

Original languageEnglish (US)
Pages (from-to)935-942
Number of pages8
JournalInternational Forum of Allergy and Rhinology
Volume6
Issue number9
DOIs
StatePublished - Sep 1 2016

Keywords

  • asthma
  • biologic therapy
  • chronic rhinosinusitis
  • eosinophils
  • molecular biomarkers
  • monoclonal antibodies
  • nasal polyps

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

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