Abstract
Background: The majority of patients with uncontrolled severe CRSwNP,
asthma, and atopic dermatitis share a similar T helper 2 type
inflammation. This so-called type 2 endotype has given rise to novel
treatments targeting specific cytokines driving inflammation in CRSwNP
like IL-4, IL-13, IL-5 and IgE. At present, the efficacy of several
biological treatments has been demonstrated in CRSwNP Aims: First
comprehensive overview of efficacy of reported biologicals for CRSwNP
based on published phase 2 and 3 data with focus on the clinically
relevant outcome parameters at 16 to 25 weeks of therapy. Methods: After
literature search, an overview was made of the reported effects of
dupilumab, mepolizumab and omalizumab treatment on patient relevant,
i.e. nasal congestion, smell loss and SNOT-22 scores, and patient
irrelevant outcome parameters, i.e. CT scan Lund-Mackay, smell test and
nasal polyp scores. Therapy duration of 16 to 25 w was chosen for
evaluation of efficacy. Results: A direct comparison of efficacy between
dupilumab, mepolizumab and omalizumab is challenging given differences
in inclusion criteria, outcome parameters and time-points of analyses.
However, consistent and major reduction of patient relevant and
irrelevant outcome parameters are found in all studies with biologicals
for CRSwNP, with most available data on dupilumab. Conclusion: Despite
the heterogeneity of protocols, dosages and time-points of analyses of
biological trials in CRSwNP, this overview is the first to highlight and
present outcomes of biological treatment in a comprehensive way.