Authors (including presenting author) :
TAI CE, HONG YF, SIN KM, Emily LEUNG
Affiliation :
M&G & ENT Tuen Mun Hospital
Introduction :
Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) generally have a high symptom burden
and poor health-related quality of life, often requiring recurring systemic corticosteroid use and repeated sinus surgery.
The Global prevalence of CRSwNP is estimated to be 1%–4%. However, for local treatments, such as surgery, do not target the underlying type 2 inflammation in the sinuses,
and can lead to high rates of recurrence, revision surgery, and unsustainable improvements in loss of sense of smell.
Biologic CRSwNP treatment are to achieve effective and sustained symptom control, minimise recurrence of polyps, and
attain better control of comorbid lower airway disease while minimising the risk of side-effects associated with
systemic corticosteroid uses and repeated sinus surgery.
Objectives :
Patient is empowered with knowledge and skills for biologic therapy for chronic rhinosinusitis with nasal polyps
Methodology :
Recruited patients with evidence of type II inflammation disease including chronic rhinosinusitis with nasal polyposis, eosinophilic asthma, considering or receiving biological therapies
to combined airway clinic (collaboration between ENT & respiratory team) for management.
We selected the appropriately patients for biological treatment in chronic rhinosinusitis with nasal polyposis (CRSwNP):
Presence of bilateral polyps in a patient who had Endoscopic Sinus Surgery and exceptional circumstances excluded (e.g., not fit for surgery)
Three criteria:
Evidence of type 2 inflammation: Tissue eosinophils ≥10/hpf, OR blood eos ≥150u/l, OR total IgE ≥100IU/ml
Need for systemic corticosteroids or contraindication to systemic steroids: ≥ 2 courses per year OR long term (>3 months) low dose steroids
Significantly impaired quality of life: SNOT-22 ≥ 40
Significant loss of smell: Anosmic on smell test (score depending on test)
Diagnosis of comorbid asthma: Asthma needing regular ICS
Result & Outcome :
Totally 9 patients had recruited for education on biologic therapy Jan- Dec 2024
Significant improvements in loss of smell in patients after the first dose
Significantly reduced polyp size and improved sinus disease
Improvements in cardinal CRSwNP symptoms (eg, nasal congestion, loss of smell, rhinorrhea), and severity of disease
After recruited for education on biologic therapy, educate the patient about the potential benefits of biologic therapy, such as reduced polyp size and improved sinus disease, and decreased reliance on other asthma medications. Also, discuss possible risks and side effects associated with biologic treatment and how they can be managed.
Thus although wider availability of current biologics are needed, additional pharmacological and non-pharmacological interventions are still required. Careful phenotypic assessment of patients including current and novel predictive biomarkers will help to choose the best biologic for each patient and guide decisions on early switching if required.
Regular communication and follow-up with healthcare professionals are essential to address any questions or concerns that may arise during the course of biologic therapy.
