ABSTRACT

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) affects 1–2.5% of the population and is associated with significant adverse effects on quality of life (QoL). CRSwNP is strongly correlated with (late onset) asthma with 30–70% of the CRSwNP patients having asthma. Health-care spending in rhinosinusitis is high, especially because of indirect costs.

Areas covered: In the last years, the recognition of endotyping as an essential presumption to precision medicine has significantly changed the integrated care pathways in the treatment of chronic rhinosinusitis. Dupilumab is the first biological available for the treatment of CRswNP, since late 2019. Treatment with dupilumab results in a significant improvement of QoL (measured as SNOT-22), rhinosinusitis disease severity, symptoms of rhinosinusitis, and especially sense of smell, nasal polyp score, Lund-Mackay CT score, and asthma outcomes (ACQ5 and FEV1) compared to placebo.

Expert opinion: At this moment, the high cost of the treatment requires careful patient selection and within the EUFOREA and EPOS2020 context, experts have tried to give guidance based on today’s data. We now need trials evaluating which patients benefit most from treatment with biologicals and in which patients the treatment is cost-effective.

摘要

简介：慢性鼻窦炎伴鼻息肉 (CRSwNP) 影响 1-2.5% 的人口，并与生活质量 (QoL) 的显着不良影响相关。CRSwNP 与（迟发性）哮喘密切相关，30-70% 的 CRSwNP 患者患有哮喘。鼻窦炎的医疗保健支出很高，特别是因为间接费用。

涵盖的领域：在过去几年中，内分型被认为是精准医学的基本假设，这显着改变了慢性鼻窦炎治疗中的综合护理途径。Dupilumab 是自 2019 年末以来第一种可用于治疗 CRswNP 的生物制剂。 Dupilumab 治疗可显着改善 QoL（以 SNOT-22 衡量）、鼻窦炎疾病严重程度、鼻窦炎症状，尤其是嗅觉、鼻息肉与安慰剂相比，Lund-Mackay CT 评分和哮喘结果（ACQ5 和 FEV1）。

专家意见：此时，高昂的治疗费用需要仔细选择患者，在EUFOREA和EPOS2020的背景下，专家们试图根据今天的数据给出指导。我们现在需要进行试验，评估哪些患者从生物制剂治疗中获益最多，哪些患者的治疗具有成本效益。