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CURRENT STANDARD OF CARE FOR UNCONTROLLED CRSwNP MAY NOT PROVIDE LONG-TERM BENEFITS1

Systemic corticosteroids2,3

  • A short course of oral corticosteroids may be beneficial for patients; however, the benefit is unlikely to persist
  • Side effects with long-term exposure may limit their potential as a chronic therapy

Surgery2,4-8

  • Surgery aims to remove nasal obstruction, improving sinus ventilation and access for topical therapies
  • Patients with recurrent chronic rhinosinusitis with nasal polyposis (CRSwNP) who need revision surgery express a predominant Type 2 inflammation phenotype (with increased IL-5, eosinophilic cationic protein, total IgE, and IgE specific to Staphylococcus aureus enterotoxin)
  • Revision surgery is often required, primarily in patients with coexisting Type 2 disease

In patients with CRSwNP, a UK study found9:

55%

had previous
sino-nasal surgeries

20%

had more than
1 operation

CRSwNP patients had a mean number of 2.98 previous surgeries (ENPs) per patient

Despite systemic corticosteroid treatment and revision surgery, there remains
an unmet medical need for patients with CRSwNP9

Biologic therapy may be a viable option for
treating certain patients with CRSwNP2
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a A study was conducted through electronic medical records at Northwestern University in Chicago, Illinois. CRSwNP, asthma, and AERD patients were identified. The following demographic and clinical features were characterized: sex, atopy, and sinus disease severity.

AERD, aspirin-exacerbated respiratory disease; ENP, endoscopic nasal polypectomy.

References: 1. Mendelsohn D, Jeremic G, Wright ED, Rotenberg BW. Revision rates after endoscopic sinus surgery: a recurrence analysis. Ann Otol Rhinol Laryngol. 2011;120(3):162-166. 2. Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(suppl 29):1-464. 3. Head K, Chong LY, Hopkins C, Philpott C, Burton MJ, Schilder AGM. Short-course oral steroids alone for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016;4:CD011991. doi:10.1002/14651858.CD011991.pub2 4. Bachert C, Pawankar R, Zhang L, et al. ICON: chronic rhinosinusitis. World Allergy Organ J. 2014;7(1):25. doi:10.1186/1939-4551-7-25 5. Vaidyanathan S, Barnes M, Williamson P, Hopkinson P, Donnan PT, Lipworth B. Treatment of chronic rhinosinusitis with nasal polyposis with oral steroids followed by topical steroids: a randomized trial. Ann Intern Med. 2011;154(5):293-302. 6. Van Zele T, Holtappels G, Gevaert P, Bachert C. Differences in initial immunoprofiles between recurrent and nonrecurrent chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy. 2014;28(3):192-198. 7. Gandhi NA, Bennett BL, Graham NMH, Pirozzi G, Stahl N, Yancopoulos GD. Targeting key proximal drivers of type 2 inflammation in disease. Nat Rev Drug Discov. 2016;15(1):35-50. 8. Stevens WW, Peters AT, Hirsch AG, et al. Clinical characteristics of patients with chronic rhinosinusitis with nasal polyps, asthma, and aspirin-exacerbated respiratory disease. J Allergy Clin lmmunol Pract. 2017;5(4):1061-1070.e3. 9. Philpott C, Hopkins C, Erskine S, et al. The burden of revision sinonasal surgery in the UK—data from the Chronic Rhinosinusitis Epidemiology Study (CRES): a cross-sectional study. BMJ Open. 2015;5:e006680. doi:10.1136/bmjopen-2014-006680