People suffering from chronic sinusitis with nasal polyps can literally breathe a sigh of relief: drugs from the group of biologics that specifically intervene in the causative disease mechanisms may make their lives easier in the future.
Widespread clinical picture with high level of suffering
Ten to fifteen percent of the adult population suffer from both chronic inflammation of the mucous membrane of the nose (rhinitis) and inflammation of the mucous membrane of the paranasal sinuses (sinusitis); this is then referred to as chronic rhinosinusitis (CRS). In some affected individuals, the mucosa also proliferates and forms polyps – a clinical picture called chronic rhinosinusitis with nasal polyps (CRSwNP). Symptoms range from obstructed nasal breathing, runny nose and olfactory dysfunction to loss of sense of smell, headaches and sleep disturbances. “In some cases, the quality of life – especially in patients with nasal polyps – is very severely restricted. For example, 30 to 70 percent of CRSwNP patients also suffer from asthma. Psychological concomitant diseases also occur,” explains Professor Dr. med. Heidi Olze, board member of the DGHNO-KHC Working Group Clinical Immunology, Allergology and Environmental Medicine.
Diagnosis and conventional therapy method
Diagnosis is based on clinical symptoms, nasal endoscopy, and computed tomography. In standard therapy, CRSwNP is treated by nasal rinses with saline and nasal glucocorticosteroids (nasal sprays containing cortisone, additionally also by sinus surgery with removal of nasal polyps and with systemic glucocorticosteroids (tablets). However, in severe cases this is often not sufficient and in some patients the polyps develop again and again.
Therapeutic approach of biologics
The immunologic mechanisms leading to chronic sinusitis with nasal polyps are now well understood. In 80 percent, the underlying cause is a type 2 inflammation, as is also known from allergic inflammations. Here, certain messenger substances or cells of the immune system – the interleukins IL-4, IL-13, IL-5 and IgE – play an important role. “Based on these findings, scientists were able to develop biologics, monoclonal antibodies, that precisely target the messenger substances interleukin 4 and interleukin 13 and IgE or the cells, the eosinophils, which are specialized white blood cells, and thus reduce inflammation,” explains Olze, director of the Department of Otolaryngology at Charité- Universitätsmedizin Berlin. They thus offer therapeutic alternatives for patients who repeatedly develop polyps under previous treatment and do not experience a lasting improvement in their sense of smell and/or nasal breathing. “As studies in many patients have shown, the two active substances dupilumab (antibody against IL4/13) and omalizumab (antibody against IgE) effectively and safely reduce nasal polyps and other symptoms of CRSwNP; patients’ quality of life improves decisively,” the expert reports. An important prerequisite for therapeutic success is evidence of severe, uncontrolled CRSwNP and underlying type 2 inflammation.
Source: German Society of Otorhinolaryngology,
Head and Neck Surgery e.V., Bonn (DGHNO-KHC)
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