BIOLOGICAL THERAPY IN CHRONIC RHINOSINUSITIS WITH NASAL POLYPS: A LITERATURE REVIEW OF TREATMENT METHODS INCLUDING DUPILUMAB AND MEPOLIZUMAB
Abstract
Introduction and purpose: Nasal polyps occur in chronic mucosal inflammation of the nasal cavity. Overgrown mucosa forms pale colored, smooth, lobular, poorly vascularized structures which expand into nasal cavity causing obstruction, nasal congestion and hyposmia. Corticosteroids used topically or systemically significantly improve patients’ quality of life by reducing the size of the polyps, however long-term steroid use is associated with systemic side effects. Sinus surgeries alleviate breathing problems, however sinonasal symptoms can reoccur even 3 years after the surgery. Recently introduced biological treatment such as mepolizumab or dupilumab, showed itself effective and safe. Studies show that patients treated with dupilumab or mepolizumab have lower risk of sinonasal symptoms reoccurrence.
The aim of this review is to investigate the treatment methods in chronic rhinosinusitis with nasal polyps and the potential of the new biological therapy.
Materials and methods: A literature review was conducted using databases including PubMed, Scopus and Google Scholar. Additionally, European position paper on rhinosinusitis and nasal polyps (2020) was used. Search terms included “chronic rhinosinusitis with nasal polyps”, “nasal polyposis”, “endoscopic sinus surgery”, “mepolizumab”, “dupilumab”.
Summary and Conclusions: Steroid therapy and endoscopic sinus surgery as a well-known form of therapies alleviate symptoms of chronic rhinosinusitis with nasal polyps although often do not offer sustain outcomes. New studies concerning biological therapy including dupilumab and mepolizumab suggest a potential breakthrough for patients. Reoccurrence rate was significantly lower, and symptom control enhanced due to biological therapeutics. Dupilumab and mepolizumab should be considered in CRSwNP treatment.
References
Albu, S., Gocea, A., & Mitre, I. (2010). Preoperative treatment with topical corticoids and bleeding during primary endoscopic sinus surgery. Otolaryngology–Head and Neck Surgery, 143(4), 573–578. https://doi.org/10.1016/j.otohns.2010.06.921
Alt, J. A., Smith, T. L., Mace, J. C., & Soler, Z. M. (2013). Sleep quality and disease severity in patients with chronic rhinosinusitis. The Laryngoscope, 123(10), 2364–2370. https://doi.org/10.1002/lary.24040
Bachert, C., Han, J. K., Desrosiers, M., Hellings, P. W., Amin, N., Lee, S. E., Mullol, J., Greos, L. S., Bosso, J. V., Laidlaw, T. M., Cervin, A. U., Maspero, J. F., Hopkins, C., Olze, H., Canonica, G. W., Paggiaro, P., Cho, S. H., Fokkens, W. J., Fujieda, S., … Mannent, L. P. (2019). Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): Results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. The Lancet, 394(10209), 1638–1650. https://doi.org/10.1016/S0140-6736(19)31881-1
Benninger, M. S., Sindwani, R., Holy, C. E., & Hopkins, C. (2015). Early versus Delayed Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis: Impact on Health Care Utilization. Otolaryngology–Head and Neck Surgery, 152(3), 546–552. https://doi.org/10.1177/0194599814565606
Chung, J. H., Lee, Y. J., Kang, T. W., Kim, K. R., Jang, D. P., Kim, I. Y., & Cho, S. H. (2015). Altered Quality of Life and Psychological Health (SCL-90-R) in Patients With Chronic Rhinosinusitis With Nasal Polyps. Annals of Otology, Rhinology & Laryngology, 124(8), 663–670. https://doi.org/10.1177/0003489415576181
DeConde, A. S., Mace, J. C., Levy, J. M., Rudmik, L., Alt, J. A., & Smith, T. L. (2017). Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. The Laryngoscope, 127(3), 550–555. https://doi.org/10.1002/lary.26391
Desrosiers, M., Diamant, Z., Castelnuovo, P., Hellings, P. W., Han, J. K., Peters, A. T., Silver, J., Smith, S. G., Fuller, A., Sousa, A. R., Chan, R. H., Gevaert, P., & the SYNAPSE study investigators. (2024). Sustained efficacy of mepolizumab in patients with severe chronic rhinosinusitis with nasal polyps: SYNAPSE 24‐week treatment‐free follow‐up. International Forum of Allergy & Rhinology, 14(1), 18–31. https://doi.org/10.1002/alr.23219
Drake-Lee, A. (2004). Nasal polyps. Hospital Medicine, 65(5), 264–267. https://doi.org/10.12968/hosp.2004.65.5.13699
Fokkens, W. J., Lund, V. J., Hopkins, C., Hellings, P. W., Kern, R., Reitsma, S., Toppila-Salmi, S., Bernal-Sprekelsen, M., Mullol, J., Alobid, I., Terezinha Anselmo-Lima, W., Bachert, C., Baroody, F., Von Buchwald, C., Cervin, A., Cohen, N., Constantinidis, J., De Gabory, L., Desrosiers, M., … Zwetsloot, C. P. (2020). European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology Journal, 0(0), 1–464. https://doi.org/10.4193/Rhin20.600
Fujieda, F., Wang, C., Yoshikawa, M., Asako, M., Suzaki, I., Bachert, C., Han, J. K., Fuller, A., Baylis, L., Su, L., Sasaki, E., Sousa, A. R., Chan, R., & Zhang, L. (2024). Mepolizumab in CRSwNP/ECRS and NP: The phase III randomised MERIT trial in Japan, China, and Russia. Rhinology Journal, 0(0), 0–0. https://doi.org/10.4193/Rhin24.156
Gevaert, P., Calus, L., Van Zele, T., Blomme, K., De Ruyck, N., Bauters, W., Hellings, P., Brusselle, G., De Bacquer, D., Van Cauwenberge, P., & Bachert, C. (2013). Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma. Journal of Allergy and Clinical Immunology, 131(1), 110-116.e1. https://doi.org/10.1016/j.jaci.2012.07.047
Harb, H., & Chatila, T. A. (2020). Mechanisms of Dupilumab. Clinical & Experimental Allergy, 50(1), 5–14. https://doi.org/10.1111/cea.13491
Hellquist, H. B. (1996a). Histopathology. Allergy and Asthma Proceedings, 17(5), 237–242. https://doi.org/10.2500/108854196778662264
Hellquist, H. B. (1996b). Nasal polyps update. Histopathology. Allergy and Asthma Proceedings, 17(5), 237–242.
Hoehle, L. P., Phillips, K. M., Bergmark, R. W., Caradonna, D. S., Gray, S. T., & Sedaghat, A. R. (2016). Symptoms of chronic rhinosinusitis differentially impact general health-related quality of life. Rhinology Journal, 54(4), 316–322. https://doi.org/10.4193/Rhino16.211
Hopkins, C., Browne, J. P., Slack, R., Lund, V., Topham, J., Reeves, B., Copley, L., Brown, P., & Van Der Meulen, J. (2006). The national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Clinical Otolaryngology, 31(5), 390–398. https://doi.org/10.1111/j.1749-4486.2006.01275.x
Howard, T. D., Koppelman, G. H., Xu, J., Zheng, S. L., Postma, D. S., Meyers, D. A., & Bleecker, E. R. (2002). Gene-Gene Interaction in Asthma: IL4RA and IL13 in a Dutch Population with Asthma. The American Journal of Human Genetics, 70(1), 230–236. https://doi.org/10.1086/338242
Kern, R. C., Stolovitzky, J. P., Silvers, S. L., Singh, A., Lee, J. T., Yen, D. M., Iloreta, A. M. C., Langford, F. P. J., Karanfilov, B., Matheny, K. E., Stambaugh, J. W., Gawlicka, A. K., & for the RESOLVE II study investigators. (2018). A phase 3 trial of mometasone furoate sinus implants for chronic sinusitis with recurrent nasal polyps. International Forum of Allergy & Rhinology, 8(4), 471–481. https://doi.org/10.1002/alr.22084
Kim, J.-Y., Ko, I., Kim, M. S., Kim, D. W., Cho, B.-J., & Kim, D.-K. (2020). Relationship of Chronic Rhinosinusitis with Asthma, Myocardial Infarction, Stroke, Anxiety, and Depression. The Journal of Allergy and Clinical Immunology: In Practice, 8(2), 721-727.e3. https://doi.org/10.1016/j.jaip.2019.09.001
Kirtsreesakul, V., Wongsritrang, K., & Ruttanaphol, S. (2012). Does Oral Prednisolone Increase the Efficacy of Subsequent Nasal Steroids in Treating Nasal Polyposis? American Journal of Rhinology & Allergy, 26(6), 455–462. https://doi.org/10.2500/ajra.2012.26.3820
Laidlaw, T. M., Mullol, J., Woessner, K. M., Amin, N., & Mannent, L. P. (2021). Chronic Rhinosinusitis with Nasal Polyps and Asthma. The Journal of Allergy and Clinical Immunology: In Practice, 9(3), 1133–1141. https://doi.org/10.1016/j.jaip.2020.09.063
Lane, A. P., Mullol, J., Hopkins, C., Fokkens, W. J., Lee, S. E., Msihid, J., Nash, S., Sacks, H., Borsos, K., Kamat, S., Rowe, P. J., Deniz, Y., & Jacob-Nara, J. A. (2025). Dupilumab improves sense of smell and clinical outcomes in patients with severe chronic rhinosinusitis with nasal polyps with anosmia. Current Medical Research and Opinion, 41(1), 53–59. https://doi.org/10.1080/03007995.2024.2434083
Lee, E. J., Hwang, H. J., Jung, C. M., Kim, M. K., Kang, M. S., & Kim, K.-S. (2017). The Relationship between Chronic Rhinosinusitis and Metabolic Syndrome. American Journal of Rhinology & Allergy, 31(4), 222–227. https://doi.org/10.2500/ajra.2017.31.4445
Mainz, J. G., & Koitschev, A. (2012). Pathogenesis and Management of Nasal Polyposis in Cystic Fibrosis. Current Allergy and Asthma Reports, 12(2), 163–174. https://doi.org/10.1007/s11882-012-0250-y
Miglani, A., Divekar, R. D., Azar, A., Rank, M. A., & Lal, D. (2018). Revision endoscopic sinus surgery rates by chronic rhinosinusitis subtype. International Forum of Allergy & Rhinology, 8(9), 1047–1051. https://doi.org/10.1002/alr.22146
Montaño-Velázquez, B. B., Flores-Rojas, E. B., García-Vázquez, F. J., Jurado-Hernandez, S., Venancio Hernández, M. A., Alanis Flores, A. K., & Jáuregui-Renaud, K. (2017). Effect of cigarette smoke on counts of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa in young patients with perennial allergic rhinitis. Brazilian Journal of Otorhinolaryngology, 83(4), 420–425. https://doi.org/10.1016/j.bjorl.2016.04.011
Mullol, J., Azar, A., Buchheit, K. M., Hopkins, C., & Bernstein, J. A. (2022). Chronic Rhinosinusitis With Nasal Polyps: Quality of Life in the Biologics Era. The Journal of Allergy and Clinical Immunology: In Practice, 10(6), 1434-1453.e9. https://doi.org/10.1016/j.jaip.2022.03.002
Patel, G. B., Kern, R. C., Bernstein, J. A., Hae-Sim, P., & Peters, A. T. (2020). Current and Future Treatments of Rhinitis and Sinusitis. The Journal of Allergy and Clinical Immunology: In Practice, 8(5), 1522–1531. https://doi.org/10.1016/j.jaip.2020.01.031
Pinto, J. M., Mehta, N., DiTineo, M., Wang, J., Baroody, F. M., & Naclerio, R. M. (2010). A randomized, double-blind, placebo-controlled trial of anti-IgE for chronic rhinosinusitis. Rhinology Journal, 48(3), 318–324. https://doi.org/10.4193/Rhino09.144
Rice, J. B., White, A. G., Scarpati, L. M., Wan, G., & Nelson, W. W. (2017). Long-term Systemic Corticosteroid Exposure: A Systematic Literature Review. Clinical Therapeutics, 39(11), 2216–2229. https://doi.org/10.1016/j.clinthera.2017.09.011
Richard, A. J., White, U., Elks, C. M., & Stephens, J. M. (2000). Adipose Tissue: Physiology to Metabolic Dysfunction. In K. R. Feingold, S. F. Ahmed, B. Anawalt, M. R. Blackman, A. Boyce, G. Chrousos, E. Corpas, W. W. de Herder, K. Dhatariya, K. Dungan, J. Hofland, S. Kalra, G. Kaltsas, N. Kapoor, C. Koch, P. Kopp, M. Korbonits, C. S. Kovacs, W. Kuohung, … D. P. Wilson (Eds.), Endotext. MDText.com, Inc. http://www.ncbi.nlm.nih.gov/books/NBK555602/
Rudmik, L., Schlosser, R. J., Smith, T. L., & Soler, Z. M. (2012). Impact of topical nasal steroid therapy on symptoms of nasal polyposis: A Meta‐Analysis. The Laryngoscope, 122(7), 1431–1437. https://doi.org/10.1002/lary.23259
Settipane, G. A. (1996). Epidemiology of Nasal Polyps. Allergy and Asthma Proceedings, 17(5), 231–236. https://doi.org/10.2500/108854196778662246
Smith, T. L., Schlosser, R. J., Mace, J. C., Alt, J. A., Beswick, D. M., DeConde, A. S., Detwiller, K. Y., Mattos, J. L., & Soler, Z. M. (2019). Long‐term outcomes of endoscopic sinus surgery in the management of adult chronic rhinosinusitis. International Forum of Allergy & Rhinology, 9(8), 831–841. https://doi.org/10.1002/alr.22369
Stevens, W. W., Schleimer, R. P., & Kern, R. C. (2016). Chronic Rhinosinusitis with Nasal Polyps. The Journal of Allergy and Clinical Immunology. In Practice, 4(4), 565–572. https://doi.org/10.1016/j.jaip.2016.04.012
Veloso-Teles, R., Cerejeira, R., Roque-Farinha, R., & Von Buchwald, C. (2018). Higher prevalence of nasal polyposis among textile workers: An endoscopic based and controlled study. Rhinology Journal, 56(2), 99–105. https://doi.org/10.4193/Rhin17.228
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