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occurs in more than 80% of Caucasian Position Paper on Rhinosinusitis and Nasal
patients with CRS with polyposis. Polyps 2020 made some modifications to
• Mepolizumab: human monoclonal antibody these criteria (Fig. 4). Biologics are currently
1
that prevents binding of circulating free IL-5 approved as a complementary therapy to
to the α subunit of IL-5R (IL-5Ra), which is intranasal corticosteroids for the treatment
expressed on the surface of eosinophils . IL-5 of adults with CRS with nasal polyps, in
20
is a key mediator in eosinophil chemotaxis, whom systemic corticosteroids and surgery
differentiation, activation, and survival, and (unless contraindicated) have not provided
demonstrates high levels in patients with adequate disease control.
CRS with polyposis.
• Dupilumab: human monoclonal antibody In clinical terms, CRS with severe sinonasal
that binds to the α subunit of the IL-4 polyposis is defined as a bilateral disease with
receptor (IL-4Rα), thus inhibiting the at least 4 (out of 8) points on the Meltzer clinical
signaling of IL-4 and IL-13, two cytokines scoring system of nasal polyposis (Endoscopic
associated with type 2 T helper (Th2) cell Nasal Polyps Score [NPS]) and persistent
activity that play an important role in the symptoms, including anosmia/ageusia,
pathogenesis of nasal polyposis . This nasal obstruction, anterior and/or posterior
21
therapy has already shown clinical benefits rhinorrhea, and facial pain/pressure, requiring
in patients with asthma and atopic eczema. other therapeutic options to complement
Until 2019, monoclonal antibodies could only treatment with topical corticosteroids
be prescribed to patients with concomitant (systemic corticosteroids and/or surgery) .
1
severe asthma. In 2019, a group of researchers When treatment fails, uncontrolled CRS is
from the European Forum for Research and defined as a persistent or recurrent disease
Education in Allergy and Airway Diseases despite long-term treatment with topical
(EUFOREA) developed criteria for the use of corticosteroids and at least one course of
biologics in patients with CRS with polyposis, systemic corticosteroids in the previous two
with or without concomitant asthma years (or having a medical contraindication or
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(Fig. 3). In 2020, the board of the European intolerance to systemic corticosteroids) and/
Figure 3
Indications for biologics, European Forum for Research and Education in Allergy and Airway Diseases
(EUFOREA).
Volume 61 . Nº2 . June 2023 161
