Introduction
The treatment for patients suffering from uncontrolled severe CRSwNP has
been subject to a revolution of care given the growing insight into the
underlying pathology over the past two decades, the recommendation to
evaluate biomarkers in the context of biologics, and the increased
awareness of comorbidities (1-3).
A better understanding of the underlying inflammatory pathways has led
to biologics emerging as an effective novel treatment option. This
option supplements the classic advanced treatment options after
appropriate medical treatment with nasal corticosteroids and rinsing for
CRSwNP, such as oral corticosteroids and endoscopic sinus surgery (4,
5).
EUFOREA is an international not-for-profit organization aiming to
prevent and reduce the burden of chronic respiratory diseases via the
implementation of optimal care. In the context of CRS, a simplified
treatment algorithm was launched, with the aim to educate all healthcare
providers dealing with CRS on the treatment options and referral
patterns, and to shorten the disease journey for CRS (6). EPOS2020 is
the 2020 version of the European Position Paper on Chronic
Rhinosinusitis and Nasal Polyps. The expert teams of both organizations
closely work together to improve management of CRS. Besides baseline
treatment with nasal rinses and intranasal corticosteroids, the
following five key pillars of specialist care have been used for
uncontrolled severe CRSwNP based on personal history and disease
journey: oral corticosteroids, primary and revision sinus surgery,
biologics and aspirin therapy after desensitization (ATAD).
For several years, biologics have been indicated and are available in a
growing number of countries for severe uncontrolled CRSwNP with the need
to define specific criteria for the indication. In that context, EUFOREA
has defined criteria for the indications of biologics in 2019 (7, 8),
which have been finetuned in 2023 (9). In contrast to biologics, no
international consensus has been reached on the specific academic
criteria for the indications of systemic corticosteroids, primary or
revision sinus surgery, or ATAD. Here, the EUFOREA/EPOS2020 expert panel
of CRS supplemented with experts of the European Rhinology Society (ERS)
and American Rhinology Society (ARS) have joined forces to agree on
criteria, outcomes, contra-indications and considerations in relation to
the different treatment options for CRSwNP. The statements of the
authors are based on extensive clinical experience and expertise and the
current scientific knowledge in relation to each therapeutic option for
CRSwNP.