For ENT physicians in private practice, the approval of biologics for the indication of chronic rhinosinusitis with polyposis nasi (CRSwNP) means on the one hand an expansion of treatment options. On the other hand, however, there is also uncertainty, e.g. with regard to economic efficiency. Real-life data are few and far between outside large centers – so one practice team initiated an analysis of its own patient data.
Since biologics such as dupilumab, omalizumab, and mepolizumab have been approved in the indication of CRSwNP, the treatment spectrum of the disease has expanded not only in ENT clinics but also in ENT practices. “With these new therapeutic approaches, we as practitioners are caught between the conflicting priorities of profitability and fears of recourse, our own curiosity and patient needs,” explain Dr. Pascal Werminghaus and his colleagues from the ENT practice Derichs, Hirschfeld + Werminghaus in Düsseldorf (D) in their poster presentation [1]. It is therefore inevitable that the clinical picture of CRSwNP is currently being scientifically sharpened as both an opportunity to help seriously ill patients and a challenge, especially with regard to its implementation in the branch office.
In a retrospective, non-controlled analysis, the physicians evaluated the treatment of 18 practice patients with CRSwNP with biologics under real-life conditions. Routinely, they recorded the severity of disease burden via the nasal polyp score (NPS) and the SNOT-22 quality-of-life questionnaire at baseline, within the first six months after treatment initiation, and after one year of treatment.
Significant effects
Of the cohort (4 female, 14 male), 11 treatments were indicated in 2022. Three therapies were started in 2020 and four more in 2021. This increase is due, on the one hand, to the fact that doctors initially treated only the very most serious cases and, encouraged by the success, are now becoming broader within the indication. On the other hand, however, there was also an increase in referrals from specialist colleagues, in particular also from pulmonary specialists, with the specific question of biologics. 44.4% of participants were recruited from their own patient base, and one-third (33.3%) were referred by pulmonary specialists. The remainder were referred by an ENT clinic or ENT specialist (11.1% each). Known T2 concomitant diseases were mainly bronchial asthma (78%) and analgesic intolerance (NERD, 56%). On average, each patient underwent two sinus surgeries.
Clear success in SNOT-22
All patients improved during the course. The success was clear in the increase in quality of life from 66 (±15) to 13 (±13) (p<0.0001) in SNOT-22, but also morphologically objectifiable showed a decrease in NPS from a mean of 5.7 (±1.2) to 3.3 (±2.3) (p=0.001) (Fig. 1). The effects proved to be clinically relevant and statistically significant already in the first six months and remained stable or improved in the further course. The therapy therefore also appears to be effective in the real-life setting of a practice and ensures a high level of satisfaction among patients. The cooperation between pulmonary specialists and ENT physicians in practice and clinic enables the optimal care of joint patients, the authors conclude.
Congress: German Allergy Congress 2022
Source:
- German Allergy Congress 2022, Poster P4.08: Real-life data on biologics treatment for chronic rhinosinusitis with nasal polyps in the outpatient setting of an ENT practice – our experience from the first 3 years.
InFo PNEUMOLOGY & ALLERGOLOGY 2022; 4(4): 36 (published 12/1/2012, ahead of print).
